Provider Demographics
NPI:1841785508
Name:CLEMONS, MINDY DAWN (OT)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:DAWN
Last Name:CLEMONS
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 1:13006 S HILLCREEK RD
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:TX
Mailing Address - Zip Code:75791-5337
Mailing Address - Country:US
Mailing Address - Phone:903-279-2570
Mailing Address - Fax:
Practice Address - Street 1:13006 S HILLCREEK RD
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:TX
Practice Address - Zip Code:75791-5337
Practice Address - Country:US
Practice Address - Phone:903-279-2570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105343225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist