Provider Demographics
NPI:1821496761
Name:CLEMENTS, SONYA G (OTR)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:G
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 NW 45TH ST STE 209
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-4613
Mailing Address - Country:US
Mailing Address - Phone:816-452-1633
Mailing Address - Fax:
Practice Address - Street 1:851 NW 45TH ST STE 209
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-4613
Practice Address - Country:US
Practice Address - Phone:816-452-1633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1700468225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist