Individual
CARLIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT, CES
Contact information
Practice address
725 UNIVERSITY BLVD, DAYTON, OH 45435-0001
(937) 245-7559
(937) 425-0736
Mailing address
1206 DICKENS DR APT A, FAIRBORN, OH 45324-8790
(614) 203-4805
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT.003570
OH
Other
Enumeration date
01/06/2016
Last updated
01/06/2016
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