Provider Demographics
NPI:1881160554
Name:PADGETT, CLARISA CAMILLE
Entity type:Individual
Prefix:
First Name:CLARISA
Middle Name:CAMILLE
Last Name:PADGETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CLARISA
Other - Middle Name:CAMILLE
Other - Last Name:MCQUEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 MCINTOSH DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-9161
Mailing Address - Country:US
Mailing Address - Phone:606-493-8259
Mailing Address - Fax:
Practice Address - Street 1:2647 REGENCY RD STE 107
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2961
Practice Address - Country:US
Practice Address - Phone:859-224-0834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY245325225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist