Provider Demographics
NPI:1457862039
Name:CLEMENT, KIMBERLEE
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 MANILA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-3208
Mailing Address - Country:US
Mailing Address - Phone:443-340-9934
Mailing Address - Fax:
Practice Address - Street 1:7320 FIRESTONE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4159
Practice Address - Country:US
Practice Address - Phone:562-927-5820
Practice Address - Fax:562-684-0102
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA19639225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program