Provider Demographics
NPI:1295037802
Name:CLARKE, LINDA MARIE (AT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:MARIE
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AT
Mailing Address - Street 1:4701 CREEK RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-8398
Mailing Address - Country:US
Mailing Address - Phone:513-733-9333
Mailing Address - Fax:513-588-2479
Practice Address - Street 1:4701 CREEK RD
Practice Address - Street 2:SUITE 110
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-8398
Practice Address - Country:US
Practice Address - Phone:513-554-8080
Practice Address - Fax:513-554-8082
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0033362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer