Shellene Clements, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

32003195A Issued in IN

Practice address

10445 Dupont Oaks Blvd
Fort Wayne, IN 46845-8792

Phone

(260) 471-4770

NPI assigned

Sep 29, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Shellene Squires Former name

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.

{
    "created_epoch": "1632873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632873600000",
    "number": "1952073918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 207",
            "city": "ASHLEY",
            "state": "IN",
            "postal_code": "467050207",
            "telephone_number": "260-687-1566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10445 DUPONT OAKS BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468458792",
            "telephone_number": "260-471-4770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMENTS",
        "first_name": "SHELLENE",
        "credential": "COTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-29",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "IN",
            "license": "32003195A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELLENE",
            "last_name": "SQUIRES",
            "credential": "COTA/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ronae Cleland, CLS
• Allison Catherine Clemens, PHARMD
• Lisa M Clemens, P.A.
• Michaela Clemens
• Zachary M Clemens, PAC
• Melissa Marie Clemmer, MS
• Claire Allison Clerkley
• Debra Clevenger, MA
• Holly J Clevenger, RN
• Sharon Freeman Clevenger, MA, MSN, PMHCNS-BC

• Occupational Therapy Assistant in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Occupational Therapy Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2021; 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.