Provider Demographics
NPI:1487391157
Name:CLAY, JUSTIN S
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:S
Last Name:CLAY
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 1:1402 WABASH AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-1755
Mailing Address - Country:US
Mailing Address - Phone:513-714-2878
Mailing Address - Fax:
Practice Address - Street 1:1402 WABASH AVE APT 5
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-1755
Practice Address - Country:US
Practice Address - Phone:513-714-2878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide