Basic Information
| Provider Information | |||||||||
| NPI: | 1255003554 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLEVY | ||||||||
| FirstName: | DEREK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10278 PERRY BLVD | ||||||||
| Address2: | |||||||||
| City: | SUMNER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624664792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185534041 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 MARY ST | ||||||||
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| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477101658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124505000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2021 | ||||||||
| LastUpdateDate: | 10/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.