Provider Demographics
NPI:1710377106
Name:HART-CLAYTOR, MICHELLE (OT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HART-CLAYTOR
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 LIGE BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-7993
Mailing Address - Country:US
Mailing Address - Phone:904-315-8525
Mailing Address - Fax:
Practice Address - Street 1:3533 CAROLWOOD LN
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4320
Practice Address - Country:US
Practice Address - Phone:904-315-8525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 15310225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist