Provider Demographics
NPI:1700269859
Name:MCLAMB, JERRI-KELLY
Entity Type:Individual
Prefix:
First Name:JERRI-KELLY
Middle Name:
Last Name:MCLAMB
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 1:2003 N SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3749
Mailing Address - Country:US
Mailing Address - Phone:910-734-4194
Mailing Address - Fax:
Practice Address - Street 1:2003 N SHAW AVE
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3749
Practice Address - Country:US
Practice Address - Phone:910-734-4194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6037225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist