Provider Demographics
NPI:1386122786
Name:CHAMBERLN, CLARESSA KAY
Entity type:Individual
Prefix:
First Name:CLARESSA
Middle Name:KAY
Last Name:CHAMBERLN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29868 KENDRICK RD
Mailing Address - Street 2:
Mailing Address - City:GREEN RIDGE
Mailing Address - State:MO
Mailing Address - Zip Code:65332-2446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29868 KENDRICK RD
Practice Address - Street 2:
Practice Address - City:GREEN RIDGE
Practice Address - State:MO
Practice Address - Zip Code:65332-2446
Practice Address - Country:US
Practice Address - Phone:660-281-5484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer