Provider Demographics
NPI:1932605235
Name:YADA, CLINTON MATTHEW (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:MATTHEW
Last Name:YADA
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N FRESNO STREET
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701
Mailing Address - Country:US
Mailing Address - Phone:559-459-1842
Mailing Address - Fax:
Practice Address - Street 1:215 N FRESNO STREET
Practice Address - Street 2:SUITE 250
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701
Practice Address - Country:US
Practice Address - Phone:559-459-1842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16214225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand