Individual
CLARK ALEXANDER WOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
813 FAY RD, SYRACUSE, NY 13219-3009
(315) 488-2951
Mailing address
132 WEBB AVE, CENTRAL SQUARE, NY 13036-8703
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
011986-1
NY
Other
Enumeration date
05/26/2010
Last updated
05/26/2010
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