Kelly Clark, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

7501007777 Issued in MI

Practice address

4488 Jackson Rd Ste 2a
Ann Arbor, MI 48103-1812

Phone

(734) 260-7235

NPI assigned

Jul 12, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720742400000",
    "number": "1134966567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 LITTLE LAKE DR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481036224",
            "telephone_number": "734-260-7235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4488 JACKSON RD STE 2A",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481031812",
            "telephone_number": "734-260-7235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KELLY",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-12",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MI",
            "license": "7501007777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ebonne Clark
• Jacqueline Elizabeth Clark, CNM
• James W. Clark, D.D.S., M.S.
• Jennifer Alicia-Becker Clark, MS, RDN, CSOWM
• Kathryn Martens Clark, NP
• Lisa Ann Clark
• Natasha R Clark, LMSW
• Nicole Ann Clark, LMSW
• Riaz Clark, LMSW
• Stephanie Michele Clark, M.D.

• Massage Therapist in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Massage Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.