Provider Demographics
NPI:1518556471
Name:CLEM, CHARLES JR (OTD, OTR)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:CLEM
Suffix:JR
Gender:M
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 S STATE ROAD 135
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-9825
Mailing Address - Country:US
Mailing Address - Phone:317-497-6000
Mailing Address - Fax:
Practice Address - Street 1:3000 S STATE ROAD 135
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-9825
Practice Address - Country:US
Practice Address - Phone:317-497-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006651A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist