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General NPI Number Information
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NPI Number | 1881712214
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Entity Type | Individual
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Provider Name | HEATHER L CLEMONS ATC
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 220 HOFSTRA UNIVERSITY 112 HOFSTRA DOME
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City | HEMPSTEAD
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State | NY
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Zip | 11549-2100
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Country | US
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Telephone | 516-463-5196
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Fax | 516-463-6275
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Provider Business Mailing Address
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Address Line | 2912 MORELAND AVE
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City | OCEANSIDE
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State | NY
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Zip | 11572-4726
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Country | US
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Telephone | 516-282-4009
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 000870-1
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License Number State | NY
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