Clementine Pediatrics, LLC

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Legal business name

CLEMENTINE PEDIATRICS, LLC

Practice address

1757 N Kimball Ave Ste 205a
Chicago, IL 60647-4805

Phone

(816) 914-0359

NPI assigned

Sep 4, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sara P Vivoda, MOT, OTR/L, CLCNPI 1124377635

Title

Owner

Phone

(816) 914-0359

Specialties & licenses 3

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sara Probasco Vivoda, MOT, OTR/L, CLC

  • Occupational Therapist
  • Chicago, IL
  • NPI 1124377635

  Lactation Consultant, Non-RN

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1693785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759276800000",
    "number": "1134905482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1757 N KIMBALL AVE STE 205A",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606474805",
            "telephone_number": "816-914-0359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1757 N KIMBALL AVE STE 205A",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606474805",
            "telephone_number": "816-914-0359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEMENTINE PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-04",
        "last_updated": "2025-10-01",
        "certification_date": "2025-10-01",
        "status": "A",
        "authorized_official_last_name": "VIVODA",
        "authorized_official_first_name": "SARA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "816-914-0359",
        "authorized_official_credential": "MOT, OTR/L, CLC"
    },
    "taxonomies": [
        {
            "code": "174N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Lactation Consultant, Non-RN",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225XF0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Feeding, Eating & Swallowing",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracey L Clemens, DPT
• Clement S Rose MD PC
• Erica L Clement, FNP-S
• Elpidio Clemente III, APRN, CRNA
• Therese L Clementi, P.T.
• Bryan David Clements II, DO, MA
• Chelsea Clements, M.S. CFY-SLP
• Kristin Burge Clemenz, MS
• Jack D Clemis, M.D.
• Jalen David Clemmons, MSW, LCSW

• Occupational Therapist in Chicago, IL
• Providers in Chicago, IL by specialty
• Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.