Individual
BRIAN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4718 TENBURY LN, ROCKLIN, CA 95677-4487
(916) 214-9597
Mailing address
4718 TENBURY LN, ROCKLIN, CA 95677-4487
Taxonomy
Speciality
Code
Description
License number
State
225XG0600X
Gerontology Occupational Therapist
Primary
5857
CA
Other
Enumeration date
01/20/2015
Last updated
01/20/2015
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