Individual
KIMBERLY CAROL CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.S. CMT
Contact information
Practice address
7901 S 12TH ST, SUITE 200, PORTAGE, MI 49024-3831
(269) 720-6833
Mailing address
8874 PINE ISLAND CT S, MATTAWAN, MI 49071-9570
(269) 720-6833
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
225700000X
MASSAGE THERAPIST
MI
Enumeration date
09/02/2013
Last updated
09/04/2013
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