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NPI Code Detail

MEDICARE: MS. RETA MARIE CLEMENS MT

MEDICARE: MS. RETA MARIE CLEMENS MT
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
1172M00000XMechanotherapist33.008286 CDOH

General Provider Information

NPI Number : 1588056352
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. RETA MARIE CLEMENS MT
Provider Business Mailing Address
First Line : 6822 WHIPPLE AVE NW
Second Line :
City : NORTH CANTON
State : OH
Zip : 44720-7336
Country : US
Telephone Number : 330-284-4687
Fax Number :
Provider Business Practice Location Address
First Line : 6822 WHIPPLE AVE NW
Second Line :
City : NORTH CANTON
State : OH
Zip : 44720-7336
Country : US
Telephone Number : 330-284-4687
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2015
Last Update Date : 03/03/2015

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Directions to “ MS. RETA MARIE CLEMENS MT” Practice Location

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