Provider Demographics
NPI:1417076654
Name:CLAYTON, MONA CAROLYN (COTA)
Entity Type:Individual
Prefix:MS
First Name:MONA
Middle Name:CAROLYN
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 FALLINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4022
Mailing Address - Country:US
Mailing Address - Phone:317-506-0180
Mailing Address - Fax:
Practice Address - Street 1:1532 FALLINGBROOK DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-4022
Practice Address - Country:US
Practice Address - Phone:317-506-0180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32000044A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN32000044AMedicare UPIN