Individual
BAILEY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
850 E MAIN ST, LAKE BUTLER, FL 32054-1353
(386) 496-2323
Mailing address
692 NE STATE ROAD 16, STARKE, FL 32091
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA17741
FL
Other
Enumeration date
04/28/2021
Last updated
04/28/2021
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