Provider Demographics
NPI:1326562232
Name:CLEMONS-LUCAS, KARLA J (OTR/L)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:J
Last Name:CLEMONS-LUCAS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5753 QUIET PINE CIR APT 304
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-7722
Mailing Address - Country:US
Mailing Address - Phone:915-491-8622
Mailing Address - Fax:
Practice Address - Street 1:300 TWINRIDGE LN
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5282
Practice Address - Country:US
Practice Address - Phone:915-491-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119007381225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist