Provider Demographics
NPI:1134353246
Name:CLEMMONS, ASTRID NICOLE (OTR/L)
Entity type:Individual
Prefix:
First Name:ASTRID
Middle Name:NICOLE
Last Name:CLEMMONS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 GHOST TRACE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-6845
Mailing Address - Country:US
Mailing Address - Phone:702-722-4476
Mailing Address - Fax:
Practice Address - Street 1:1824 GHOST TRACE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-6845
Practice Address - Country:US
Practice Address - Phone:702-722-4476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV09-0087225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics