Provider Demographics
NPI:1356508303
Name:CLOW, JEANNE L (OT)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:L
Last Name:CLOW
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 WOODED RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:COLGATE
Mailing Address - State:WI
Mailing Address - Zip Code:53017-9375
Mailing Address - Country:US
Mailing Address - Phone:262-628-9311
Mailing Address - Fax:
Practice Address - Street 1:ST. JOSEPH'S REGIONAL MEDICAL CENTER
Practice Address - Street 2:5000 W. CHAMBERS ST
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210
Practice Address - Country:US
Practice Address - Phone:414-447-2209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1730-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist