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JACKIE CLARK

>> Occupational Therapist >> Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Registrant NPI Number: 1124474457

Individual Registrant:
 JACKIE  CLARK 
Gender: M
Not Sole Proprietor

Location and contact information for practice:
11472 WALDEN LOOP  PARRISH, FL 34219-7565 US
Tel: 941-806-7555  Fax: --

Contact information for business:
11472 WALDEN LOOP  PARRISH, FL 34219-7565 US
Tel: 941-806-7555  Fax: --

Registration Information:
NPI: 1124474457
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Occupational Therapist
FLOT14395

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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