Provider Demographics
NPI:1033557582
Name:MUCHOW, CLAIRE DUVALL
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:DUVALL
Last Name:MUCHOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:DUVALL
Other - Last Name:SALISBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:113 JOHNSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2028
Mailing Address - Country:US
Mailing Address - Phone:859-224-2273
Mailing Address - Fax:
Practice Address - Street 1:113 JOHNSTON BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2028
Practice Address - Country:US
Practice Address - Phone:919-801-3426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2013-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
TX114451225XP0200X
KYR5569225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100253240Medicaid
KY7100253240Medicaid