Individual
JASON CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
140 TECHNOLOGY LN, JOHNSON CITY, TN 37604-2004
(423) 979-0798
Mailing address
420 WYNDHAM DR, GRAY, TN 37615-5229
(352) 359-6252
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4141
TN
Other
Enumeration date
06/09/2011
Last updated
06/09/2011
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