Provider Demographics
NPI:1114629821
Name:MCCLEARY, EMMA JANE (OTR/L)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:JANE
Last Name:MCCLEARY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 HERON DR NW APT 101J
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-1642
Mailing Address - Country:US
Mailing Address - Phone:231-349-4955
Mailing Address - Fax:
Practice Address - Street 1:48 HERON DR NW APT 101J
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-1642
Practice Address - Country:US
Practice Address - Phone:231-349-4955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201013292225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist