Individual
MIKE A CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
444 N WELLS ST STE 304, CHICAGO, IL 60610-4593
(708) 757-5362
Mailing address
23235 S VOLBRECHT RD, CRETE, IL 60417-1789
(708) 757-5362
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
31001679A
IN
225X00000X
Occupational Therapist
Primary
—
IL
Other
Enumeration date
05/31/2007
Last updated
07/08/2007
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