Provider Demographics
NPI:1770557613
Name:MCCLELLAND, DERON ROBERT (ATC)
Entity type:Individual
Prefix:MR
First Name:DERON
Middle Name:ROBERT
Last Name:MCCLELLAND
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
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Mailing Address - Street 1:401 BURTON ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MI
Mailing Address - Zip Code:49236-9767
Mailing Address - Country:US
Mailing Address - Phone:517-214-3174
Mailing Address - Fax:734-429-0205
Practice Address - Street 1:420 W RUSSELL ST
Practice Address - Street 2:SUITE 107
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1160
Practice Address - Country:US
Practice Address - Phone:734-429-1595
Practice Address - Fax:734-429-0205
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer