Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 5201005666 | MI |
NPI | 1386964245 |
---|---|
Provider Name | Brad Allen Clarkson |
First Address | Midland, MI 48706 |
Second Address | Midland, MI 48642-9316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2010 |
Last Update Date | 02/06/2010 |