Provider Demographics
NPI:1427791854
Name:CLAYTON, ANTONIA FAITH
Entity type:Individual
Prefix:
First Name:ANTONIA
Middle Name:FAITH
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:
Other - Last Name:CLAYTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1515 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-3354
Mailing Address - Country:US
Mailing Address - Phone:309-991-9286
Mailing Address - Fax:
Practice Address - Street 1:1 MEMORIAL STADIUM DRIVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508
Practice Address - Country:US
Practice Address - Phone:407-472-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer