Individual
MRS. JAYMIE CLAIRE CLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
11811 FM 1960 WEST, SUITE 102, HOUSTON, TX 77065
(281) 469-8163
(281) 469-5559
Mailing address
12619 LAUREL MEADOW WAY, HOUSTON, TX 77014
(281) 893-4076
(281) 469-5559
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
110009
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8T1955
BLUE CROSS BLUE SHIELD
TX
Enumeration date
03/09/2006
Last updated
11/21/2007
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