Provider Demographics
NPI:1548531072
Name:CLEMETSON, KERRY BROOKE
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:BROOKE
Last Name:CLEMETSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11504 W 135TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-2892
Mailing Address - Country:US
Mailing Address - Phone:913-681-9909
Mailing Address - Fax:913-681-9906
Practice Address - Street 1:11504 W 135TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66221-2892
Practice Address - Country:US
Practice Address - Phone:913-681-9909
Practice Address - Fax:913-681-9906
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist