Provider Demographics
NPI:1326312216
Name:BECKHAM, CLEMENCE DENISE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:CLEMENCE
Middle Name:DENISE
Last Name:BECKHAM
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-6075
Mailing Address - Country:US
Mailing Address - Phone:321-332-2028
Mailing Address - Fax:
Practice Address - Street 1:405 S SEMINOLE AVE
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-5520
Practice Address - Country:US
Practice Address - Phone:352-394-0212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12166208000000X
224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No208000000XAllopathic & Osteopathic PhysiciansPediatrics