Provider Demographics
NPI:1477316784
Name:CLAY, VERONICA RACHEL (LMT)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:RACHEL
Last Name:CLAY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 KING EDWARD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5604
Mailing Address - Country:US
Mailing Address - Phone:803-487-2142
Mailing Address - Fax:
Practice Address - Street 1:636 LONG POINT RD UNIT D
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8286
Practice Address - Country:US
Practice Address - Phone:803-487-2142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13070225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist