Provider Demographics
NPI:1790740389
Name:CLEVELAND, CAROL LOUISE PEAR (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LOUISE PEAR
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:LOUISE
Other - Last Name:PEAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:389 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2308
Mailing Address - Country:US
Mailing Address - Phone:203-675-0124
Mailing Address - Fax:
Practice Address - Street 1:389 MAIN ST
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2308
Practice Address - Country:US
Practice Address - Phone:203-675-0124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002857225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist