Clark, De'Atra Pruett

Clark, De'Atra Pruett is an individual health care provider with primary practice located at 1325 San Marco Blvd Ste 102, Jacksonville FL 32207-8549. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist, which is considered as her primary health care specialty. Clark, De'Atra Pruett can be contacted via phone (904) 858-7045.

Contact Information

Primary practice address
1325 San Marco Blvd Ste 102 Jacksonville FL 32207-8549
Phone: (904) 858-7045
Fax: (904) 858-7047
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist 225X00000X OT0007576 Florida

Profile Details

NPI number 1164427209
LBN Legal business name Clark, De'Atra Pruett
Credentials Occupational Therapist (OT)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 16th, 2005
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Popular Providers