De'atra Pruett Clark, OT
NPI #1164427209 in Jacksonville, Florida
Provider Information
- NPI Number
- 1164427209
- Entity Type
- Individual
- Name
- De'atra Pruett Clark, OT
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Occupational Therapist
- Credential
- OT
- Enumeration Date
- Jun 16, 2005
- Last Updated
- Jul 8, 2007
Practice Location
- Address
- 1325 SAN MARCO BLVD
- Address 2
- STE 102
- City
- Jacksonville
- State
- Florida
- ZIP Code
- 32207-8549
- Phone
- (904) 858-7045
Specialties & Taxonomy Codes
| Specialty |
|---|
| Occupational Therapist |
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