Provider Demographics
NPI:1508037813
Name:CLOUGH, CATHERINE PEARL (COTA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:PEARL
Last Name:CLOUGH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1666 HIGH QUEST CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-3359
Mailing Address - Country:US
Mailing Address - Phone:573-999-0933
Mailing Address - Fax:
Practice Address - Street 1:1666 HIGH QUEST CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-3359
Practice Address - Country:US
Practice Address - Phone:573-999-0933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005154224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant