MEDICARE: GEORQUETTA M CLEMONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	33.022698	OH

General Provider Information

NPI Number	:	1295323657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORQUETTA M CLEMONS

Provider Business Mailing Address
First Line	:	9104 SHIPHERD CT
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1041
Country	:	US
Telephone Number	:	216-820-8343
Fax Number	:

Provider Business Practice Location Address
First Line	:	9104 SHIPHERD CT
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1041
Country	:	US
Telephone Number	:	216-820-8343
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2021
Last Update Date	:	01/01/2021

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Directions to “ GEORQUETTA M CLEMONS ” Practice Location

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