Provider Demographics
NPI:1619090164
Name:CLAYTON, VICTORIA JOLE'ANN (BS, OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:JOLE'ANN
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:BS, OTR/L, CHT
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:HAMERNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:803-935-8292
Mailing Address - Fax:423-622-6249
Practice Address - Street 1:3016 LONGTOWN COMMONS DR STE 115
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7849
Practice Address - Country:US
Practice Address - Phone:803-314-0529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT3887225X00000X
SC3259225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics