Individual
MAKAYLA CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
19 LADY SLIPPER TRL, CHARLESTOWN, RI 02813-3414
(401) 474-7500
Mailing address
PO BOX 662, CHARLESTOWN, RI 02813-0662
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
001031
CT
2255A2300X
Athletic Trainer
Primary
00397
RI
Other
Enumeration date
10/24/2016
Last updated
10/24/2016
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