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General NPI Number Information
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NPI Number | 1043012750
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Entity Type | Individual
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Provider Name | JENNIFER G CLARK MOT, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 108 MYRTLE RIDGE RD
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City | LUTZ
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State | FL
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Zip | 33549-5645
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Country | US
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Telephone | 813-803-3470
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Fax |
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Provider Business Mailing Address
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Address Line | 4548 BRAESGATE CT
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City | LAND O LAKES
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State | FL
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Zip | 34639-6440
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Country | US
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Telephone | 813-337-9458
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 26023
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License Number State | FL
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