Individual
JACOB EARL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, AT, NR-EMT
Contact information
Practice address
116 S LANE ST, BLISSFIELD, MI 49228-1206
(517) 486-5278
Mailing address
3503 WILLOW BROOK LN, TOLEDO, OH 43611-3018
(419) 906-5086
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
05/29/2018
Last updated
10/04/2019
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