Individual
MR. KEVIN JOHN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCPO
Contact information
Practice address
411 12TH AVE, SUITE 200, SEATTLE, WA 98122-5599
(206) 328-4276
(206) 328-1037
Mailing address
411 12TH AVE, SUITE 200, SEATTLE, WA 98122-5599
(206) 328-4276
(206) 328-1037
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
01 60414623
WA
224P00000X
Prosthetist
PS 60414610
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9015561
—
WA
Enumeration date
11/22/2013
Last updated
11/22/2013
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