Provider Demographics
NPI:1225639917
Name:MCCLENDON, RESHA L (CMA, LMT)
Entity Type:Individual
Prefix:MRS
First Name:RESHA
Middle Name:L
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:CMA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 DORCHESTER SQ S STE 201
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-7400
Mailing Address - Country:US
Mailing Address - Phone:614-638-1515
Mailing Address - Fax:
Practice Address - Street 1:132 DORCHESTER SQ S STE 201
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-7400
Practice Address - Country:US
Practice Address - Phone:614-638-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.015332225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist