Provider Demographics
NPI:1194489377
Name:CLUKEY, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:CLUKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 STILES RD STE 203
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-4804
Mailing Address - Country:US
Mailing Address - Phone:855-390-7774
Mailing Address - Fax:855-734-4666
Practice Address - Street 1:587 N DEER ISLE RD
Practice Address - Street 2:
Practice Address - City:DEER ISLE
Practice Address - State:ME
Practice Address - Zip Code:04627-3438
Practice Address - Country:US
Practice Address - Phone:855-390-7774
Practice Address - Fax:855-734-4666
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
METO4188225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
METO4188OtherME STATE OTR/L LICENSE