Individual
MRS. ADRIENNE RENEE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC/LAT
Contact information
Practice address
2312 S DIXON RD, SUITE 250, KOKOMO, IN 46902-6401
(765) 455-2122
Mailing address
101 S CHURCH ST, ELWOOD, IN 46036-8426
(765) 437-1117
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001446A
IN
Other
Enumeration date
12/29/2011
Last updated
12/29/2011
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