Jennifer Marie Clements, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

1672-19 Issued in WI

Practice address

330 Robin Hood LN
Gillett, WI 54124-9201

Phone

(920) 855-2136

NPI assigned

Dec 8, 2011

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 8, 2011.

{
    "created_epoch": "1323302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323302400000",
    "number": "1366710063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 MADISON ST",
            "city": "OCONTO",
            "state": "WI",
            "postal_code": "541531611",
            "telephone_number": "920-604-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 ROBIN HOOD LN",
            "city": "GILLETT",
            "state": "WI",
            "postal_code": "541249201",
            "telephone_number": "920-855-2136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMENTS",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-12-08",
        "last_updated": "2011-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "1672-19",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roberta Baldwin, RN
• Natasha Maire Bubolz, LPN
• Tori Lynn Bushmaker, OTR/L, MOT
• Jessica C Carriveau, PT
• Brianna Cibulka
• Community Memorial Hospital
• Cooperative Educational Service Agency No 8
• Steven P Drake, OD
• Gillett Area Ambulance Service Inc.
• Gillett Dental Care, S.C.

• All providers in Gillett, WI
• Physical Therapy Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2011; 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.