Individual
JACKIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11472 WALDEN LOOP, PARRISH, FL 34219-7565
(941) 806-7555
Mailing address
11472 WALDEN LOOP, PARRISH, FL 34219-7565
(941) 806-7555
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT14395
FL
Other
Enumeration date
05/05/2016
Last updated
12/06/2016
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