Provider Demographics
NPI:1972714111
Name:CLEMENTS, OLLIE H (DT)
Entity Type:Individual
Prefix:
First Name:OLLIE
Middle Name:H
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9956 S LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-1340
Mailing Address - Country:US
Mailing Address - Phone:773-981-3761
Mailing Address - Fax:
Practice Address - Street 1:287 CLARIDGE CIR
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-6184
Practice Address - Country:US
Practice Address - Phone:630-759-6673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist