Provider Demographics
NPI:1417380544
Name:JEWELL, CLAYTON J (OTRL)
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:J
Last Name:JEWELL
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5785 ADA DR SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-7832
Mailing Address - Country:US
Mailing Address - Phone:616-888-1788
Mailing Address - Fax:616-741-2310
Practice Address - Street 1:2020 RAYBROOK ST SE STE 204-B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7717
Practice Address - Country:US
Practice Address - Phone:616-888-1788
Practice Address - Fax:616-741-2310
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008466225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist