Individual
MRS. ERIN MARIE CLEMENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
2235 TACKETTS MILL DR, SUITE C, WOODBRIDGE, VA 22192-3036
(703) 491-1044
(703) 491-2044
Mailing address
2235 TACKETTS MILL DR, SUITE C, WOODBRIDGE, VA 22192-3036
(703) 491-1044
(703) 491-2044
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
0119005220
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
142TP
BLUE CROSS BLUE SHIELD
NC
05
—
7301756
—
NC
Enumeration date
01/02/2007
Last updated
09/04/2012
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