Provider Demographics
NPI:1215389135
Name:BARNES-RICKETT, CLAYTON ROSS (OT/L)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:ROSS
Last Name:BARNES-RICKETT
Suffix:
Gender:M
Credentials:OT/L
Other - Prefix:
Other - First Name:CLAYTON
Other - Middle Name:ROSS
Other - Last Name:RICKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7125 SE LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-4051
Mailing Address - Country:US
Mailing Address - Phone:972-825-3561
Mailing Address - Fax:
Practice Address - Street 1:8625 SW CASCADE AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-7121
Practice Address - Country:US
Practice Address - Phone:877-755-8940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-02
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR356396225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist