Individual
JONATHAN WILSON CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
3175 POCAHONTAS RD, BAKER CITY, OR 97814-1434
(541) 523-4415
Mailing address
3510 8TH DR, BAKER CITY, OR 97814-1516
(801) 413-4395
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
342831
OR
Other
Enumeration date
10/06/2015
Last updated
10/06/2015
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