Provider Demographics
NPI:1699916270
Name:CLAYBROOK, DANETTA I (MA, OTR/L)
Entity type:Individual
Prefix:
First Name:DANETTA
Middle Name:I
Last Name:CLAYBROOK
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 N CHAMPION ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44503-1602
Mailing Address - Country:US
Mailing Address - Phone:330-480-9362
Mailing Address - Fax:330-480-9407
Practice Address - Street 1:17 N CHAMPION ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44503-1602
Practice Address - Country:US
Practice Address - Phone:330-480-9362
Practice Address - Fax:330-480-9407
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT005584174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist