Provider Demographics
NPI:1154510501
Name:CLEMENS, ANN LOUISE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:LOUISE
Last Name:CLEMENS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MISS
Other - First Name:ANN
Other - Middle Name:LOUISE
Other - Last Name:ABDALLAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2978 US HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:13439-2804
Mailing Address - Country:US
Mailing Address - Phone:315-858-0827
Mailing Address - Fax:
Practice Address - Street 1:2978 US HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:RICHFIELD SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:13439-2804
Practice Address - Country:US
Practice Address - Phone:315-858-0827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005115-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant