Provider Demographics
NPI:1649900291
Name:CLAY, LARISE T
Entity type:Individual
Prefix:
First Name:LARISE
Middle Name:T
Last Name:CLAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9930 MANGHAM DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-1753
Mailing Address - Country:US
Mailing Address - Phone:513-537-3127
Mailing Address - Fax:
Practice Address - Street 1:9930 MANGHAM DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-1753
Practice Address - Country:US
Practice Address - Phone:513-537-3127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health