Jacqueline Clemons, LOTR
Individual provider Active NPI Occupational Therapist · Archdale, NC
NPI 1003187451 · NPPES record last updated Jan 22, 2026
Key facts
- NPI
- 1003187451
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 5927 (NC)
- Practice address
- 625 Ashland St
Archdale, NC 27263-2943 - Phone
- (336) 434-2902
- Fax
- (336) 434-4477
- NPI assigned
- Jan 17, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 1998
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
101 E State St
Kennett Square, PA 19348-3109
101 E State St
Attn Powerback Credentialing
Kennett Square, PA 19348-3166
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260127000361 | NC | Practitioner - Occupational Therapist in Private Practice | 1254818750 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5927 | NC | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Powerback Rehabilitation LLC | Occupational Therapist | Current |
Accepting new patients |
| Powerback Rehabilitation LLC | Occupational Therapist | Current |
Accepting new patients |
Locations
101 E State St
Kennett Square, PA 19348
Phone (610) 925-4436
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 5927 | NC | Yes |
Addresses
Primary practice location
625 Ashland St
Archdale, NC 27263-2943
Mailing address
5543 Frances CT
Winston Salem, NC 27105-1772
Phone (336) 624-3454
Other providers in Archdale, NC
- Carolina Drug of Randolph County LLC
- Nancy Barham Carter
- Chad J. Miller DDS PA
- Claudia Melton, Inc
- Chelsie Claus
- Russell Floyd Cole
- Diana Bernice Muth Cooper
- Cornerstone Health Care PA
- Creative Home Health Care LLC
- Annemarie D'Andrea
All providers in Archdale, NC · Occupational Therapist in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.