Individual
JACQUELINE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, CSCS
Contact information
Practice address
550 HUNTINGTON AVE, BOSTON, MA 02115-5901
(617) 989-4144
(617) 989-4150
Mailing address
47 PARAGON RD UNIT 2, WEST ROXBURY, MA 02132-5127
(617) 759-2912
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1867
MA
Other
Enumeration date
06/04/2014
Last updated
06/04/2014
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