Provider Demographics
NPI:1629540737
Name:MCCLOUD, WHITNEY ELISE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:ELISE
Last Name:MCCLOUD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MRS
Other - First Name:WHITNEY
Other - Middle Name:ELISE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA/L
Mailing Address - Street 1:903 W BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31643-3719
Mailing Address - Country:US
Mailing Address - Phone:229-305-5266
Mailing Address - Fax:
Practice Address - Street 1:903 W BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:GA
Practice Address - Zip Code:31643-3719
Practice Address - Country:US
Practice Address - Phone:229-305-5266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001717224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant