Provider Demographics
NPI:1336615962
Name:CLEMONS, MAUREEN (OTD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 MILLSTONE CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95258-9791
Mailing Address - Country:US
Mailing Address - Phone:209-200-2891
Mailing Address - Fax:
Practice Address - Street 1:900 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-1282
Practice Address - Country:US
Practice Address - Phone:209-333-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT19166225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist