Individual
JAMIE WALLACE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSOTR/L
Contact information
Practice address
959 CONGRESS ST, PORTLAND, ME 04102-2715
(207) 699-5600
(207) 699-5588
Mailing address
1145 BRIGHTON AVE, PORTLAND, ME 04102-1075
(207) 541-6523
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT2950
ME
Other
Enumeration date
01/21/2021
Last updated
12/19/2023
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