Individual
KENYETTA CLARKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8481 HOLLY RD, GRAND BLANC, MI 48439-1812
(810) 694-6382
Mailing address
8481 HOLLY RD, GRAND BLANC, MI 48439
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202007550
MI
Other
Enumeration date
11/14/2013
Last updated
11/14/2013
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