Kelly Clark, LMT
Massage Therapist in Ann Arbor, MI. Individual provider (NPI-1).
NPI number1134966567
StatusActive
Last updated in NPPESJul 12, 2024
Details
- NPI
- 1134966567
- Entity type
- Individual (NPI-1)
- Name
- Kelly Clark
- Credential
- LMT
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jul 12, 2024
- Certification date
- Jul 12, 2024
- Last updated
- Jul 12, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225700000X | Massage Therapist | 7501007777 | MI | Yes |
Practice location
4488 Jackson Rd Ste 2aAnn Arbor, MI 48103-1812
Phone 734-260-7235
Mailing address
509 Little Lake DrAnn Arbor, MI 48103-6224
Phone 734-260-7235
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