Active NPI
Clemence Denise Beckham, COTA/L
- Occupational Therapy Assistant
- Minneola, FL
National Provider Identifier
1326312216
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- Practice address
- 405 S Seminole Ave
Minneola, FL 34715-5520 - Phone
- (352) 394-0212
- NPI assigned
- Feb 24, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | OTA12166 | FL | |
| Occupational Therapy Assistant | 224Z00000X | Primary |
Addresses
Primary practice location
405 S Seminole Ave
Minneola, FL 34715-5520
Mailing address
733 Liberty Ave
Mount Dora, FL 32757-6075
Phone (321) 332-2028
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTA12166 | FL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1504051200000",
"number": "1326312216",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "733 LIBERTY AVE",
"city": "MOUNT DORA",
"state": "FL",
"postal_code": "327576075",
"telephone_number": "321-332-2028"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 S SEMINOLE AVE",
"city": "MINNEOLA",
"state": "FL",
"postal_code": "347155520",
"telephone_number": "352-394-0212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BECKHAM",
"first_name": "CLEMENCE",
"middle_name": "DENISE",
"name_prefix": "Ms.",
"credential": "COTA/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-02-24",
"last_updated": "2017-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "OTA12166",
"primary": false
},
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneola, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.