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Individual

JACOB C CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
7800 W OUTER DR STE 300, DETROIT, MI 48235-3458
(313) 340-4442
Mailing address
27085 GRATIOT AVE STE 101, ROSEVILLE, MI 48066-2984
(586) 204-5560

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
52002008500
MI

Other

Enumeration date
02/10/2020
Last updated
02/10/2020
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