Provider Demographics
NPI:1154757284
Name:CLEMENT, ERICA RENEE (MS OTR/L)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:RENEE
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 DOX AVE
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NY
Mailing Address - Zip Code:14172-9521
Mailing Address - Country:US
Mailing Address - Phone:716-531-8957
Mailing Address - Fax:
Practice Address - Street 1:229 DOX AVE
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NY
Practice Address - Zip Code:14172-9521
Practice Address - Country:US
Practice Address - Phone:716-531-8957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017771-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist