Organization
CLEMENTINE PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARA P VIVODA MOT, OTR/L, CLC (OWNER)
(816) 914-0359
Entity
Organization
Contact information
Practice address
1757 N KIMBALL AVE STE 205A, CHICAGO, IL 60647-4805
(816) 914-0359
Mailing address
1757 N KIMBALL AVE STE 205A, CHICAGO, IL 60647-4805
(816) 914-0359
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
—
—
225X00000X
Occupational Therapist
Primary
—
—
225XF0002X
Feeding, Eating & Swallowing Occupational Therapist
—
—
Other
Enumeration date
09/04/2023
Last updated
10/01/2025
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