Provider Demographics
NPI:1487784732
Name:CLUKEY, JOANNE A (COTA)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:A
Last Name:CLUKEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BEECHWOOD HOLW
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02808-1707
Mailing Address - Country:US
Mailing Address - Phone:401-315-2229
Mailing Address - Fax:
Practice Address - Street 1:20 BEECHWOOD HOLW
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:RI
Practice Address - Zip Code:02808-1707
Practice Address - Country:US
Practice Address - Phone:401-315-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOTA00387390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIOTA00387OtherOCC. THERAPY ASSIT.