Provider Demographics
NPI:1760035794
Name:MCCLENDON, YAHEIYA SHARONDELE (COTA / L)
Entity Type:Individual
Prefix:
First Name:YAHEIYA
Middle Name:SHARONDELE
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:COTA / L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 N WILLOWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77703-2645
Mailing Address - Country:US
Mailing Address - Phone:409-600-7677
Mailing Address - Fax:
Practice Address - Street 1:3235 N WILLOWOOD LN
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77703-2645
Practice Address - Country:US
Practice Address - Phone:409-600-7677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213584224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNAOtherSELF
TXNAOtherNA