Provider Demographics
NPI:1235621129
Name:CLARKE, CATHERINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:GALLIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 MOMAR DR
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1419
Mailing Address - Country:US
Mailing Address - Phone:201-824-3945
Mailing Address - Fax:
Practice Address - Street 1:12 MOMAR DR
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1419
Practice Address - Country:US
Practice Address - Phone:201-824-3945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00824500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist