Individual
JESSICA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7 CEDAR GROVE LN STE 39, SOMERSET, NJ 08873-1331
(732) 469-5680
(732) 868-1422
Mailing address
576 BROADHOLLOW RD, MELVILLE, NY 11747-5002
(631) 359-5859
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
46TR01048500
NJ
Other
Enumeration date
06/20/2022
Last updated
06/20/2022
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