Most Relevant Information
Provider Data
| NPI Number: | 1003299017 |
| Provider Name: | THERESA AVILA THELEN-CLEMMONS OTR/L |
| Entity Type: | Individual |
| Taxonomy Code: | 225XP0200X |
| Specialty: | Occupational Therapist |
| License Number: | 0197491 |
Most Important Dates
| Enumeration Date: | 07/08/2015 |
| Last Updated: | 07/08/2015 |
Provider Practice Location
88 MESEROLE AVE APT 2D
BROOKLYN
NY
112222675
Practice Location Phone/Fax
| Phone: | 2067692098 |
| Fax: |
Provider Mailing Location
88 MESEROLE AVE APT 2D
BROOKLYN
NY
112222675
Provider Mailing Phone/Fax
| Phone: | 2067692098 |
| Fax: |