Provider Demographics
NPI:1831784909
Name:CLEMONS, TRINA TANDREA (MOT)
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:TANDREA
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8105 TIMBERBROOKE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3350
Mailing Address - Country:US
Mailing Address - Phone:410-258-0497
Mailing Address - Fax:
Practice Address - Street 1:8105 TIMBERBROOKE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3350
Practice Address - Country:US
Practice Address - Phone:410-258-0497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05639225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist