Provider Demographics
NPI:1710258512
Name:BELL, CLYDE HAMILTON JR (OTR)
Entity Type:Individual
Prefix:
First Name:CLYDE
Middle Name:HAMILTON
Last Name:BELL
Suffix:JR
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 NW 46TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7209
Mailing Address - Country:US
Mailing Address - Phone:352-372-5789
Mailing Address - Fax:
Practice Address - Street 1:3545 NW 46TH TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7209
Practice Address - Country:US
Practice Address - Phone:352-372-5789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT3144225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist