Provider Demographics
NPI:1487322087
Name:CLAYTON, OWEN MATTHEW
Entity type:Individual
Prefix:MR
First Name:OWEN
Middle Name:MATTHEW
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 HUNTER DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-2057
Mailing Address - Country:US
Mailing Address - Phone:630-745-0215
Mailing Address - Fax:
Practice Address - Street 1:32 HUNTER DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-2057
Practice Address - Country:US
Practice Address - Phone:630-745-0215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer