Individual
KASSIE JO LOVELY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,OT/L
Contact information
Practice address
79 BLAKE ST, SUITE 1, PRESQUE ISLE, ME 04769-2474
(207) 764-3036
Mailing address
408 GRIFFIN RIDGE RD, MAPLETON, ME 04757-4415
(207) 227-6538
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
TO2657
ME
Other
Enumeration date
08/10/2012
Last updated
08/17/2020
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