Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 210483 | TX |
NPI | 1003136821 |
---|---|
Provider Name | Jennifer Bowlin Clark |
First Address | Iola, TX 77861-4321 |
Second Address | Bryan, TX 77802-5215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2010 |
Last Update Date | 15/04/2014 |