Individual
JESSICA JOLENE STARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
4040 BEACON ST, KINGSLEY, MI 49649-9548
(231) 263-1350
Mailing address
3889 WALTON RD, KINGSLEY, MI 49649-9639
(906) 630-0494
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
54643
MI
Other
Enumeration date
03/14/2022
Last updated
03/14/2022
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