Provider Demographics
NPI:1457418121
Name:CLEMENS, ERIN MARIE (OTRL)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:MARIE
Last Name:CLEMENS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 TACKETTS MILL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-3036
Mailing Address - Country:US
Mailing Address - Phone:703-491-1044
Mailing Address - Fax:703-491-2044
Practice Address - Street 1:2235 TACKETTS MILL DR
Practice Address - Street 2:SUITE C
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-3036
Practice Address - Country:US
Practice Address - Phone:703-491-1044
Practice Address - Fax:703-491-2044
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005220225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC142TPOtherBLUE CROSS BLUE SHIELD
NC7301756Medicaid