Provider Demographics
NPI:1619090206
Name:CLEMMENS, ASHLEIGH AMBER (COTA)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEIGH
Middle Name:AMBER
Last Name:CLEMMENS
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 1:505 KELLER AVE S
Mailing Address - Street 2:
Mailing Address - City:AMERY
Mailing Address - State:WI
Mailing Address - Zip Code:54001-1200
Mailing Address - Country:US
Mailing Address - Phone:715-268-6900
Mailing Address - Fax:
Practice Address - Street 1:505 KELLER AVE S
Practice Address - Street 2:
Practice Address - City:AMERY
Practice Address - State:WI
Practice Address - Zip Code:54001-1200
Practice Address - Country:US
Practice Address - Phone:715-268-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1841-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40859600Medicaid