Provider Demographics
NPI:1881725448
Name:CLEMMER, GAI LEIGH (ATC)
Entity type:Individual
Prefix:
First Name:GAI
Middle Name:LEIGH
Last Name:CLEMMER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 W MAIN ST APT 4
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2057
Mailing Address - Country:US
Mailing Address - Phone:989-723-4060
Mailing Address - Fax:989-729-6481
Practice Address - Street 1:216 E COMSTOCK ST
Practice Address - Street 2:SUITE C
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-3161
Practice Address - Country:US
Practice Address - Phone:989-729-2929
Practice Address - Fax:989-729-6481
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer