Provider Demographics
NPI:1114000890
Name:RICHARDSON, CLAIRE (OTRL)
Entity Type:Individual
Prefix:MISS
First Name:CLAIRE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13680
Mailing Address - Country:US
Mailing Address - Phone:315-244-9937
Mailing Address - Fax:
Practice Address - Street 1:1942 OLD DEKALB ROAD
Practice Address - Street 2:NEW DIMENSIONS IN HEALTH CARE
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617
Practice Address - Country:US
Practice Address - Phone:315-386-3529
Practice Address - Fax:315-386-4071
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0106571225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist