Provider Demographics
NPI:1528803111
Name:CLEMENTS, NICOLE ESSLEY (OTR)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ESSLEY
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13675 NOEL RD APT 326
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-4796
Mailing Address - Country:US
Mailing Address - Phone:210-240-4325
Mailing Address - Fax:
Practice Address - Street 1:3501 JUNIUS ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2021
Practice Address - Country:US
Practice Address - Phone:214-820-2683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124666225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist