Provider Demographics
NPI:1851527626
Name:MCCLOUD, RONAE DIANA (OTR/L)
Entity Type:Individual
Prefix:
First Name:RONAE
Middle Name:DIANA
Last Name:MCCLOUD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 TURKEYFOOT RD
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE PARK
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2526
Mailing Address - Country:US
Mailing Address - Phone:859-426-5786
Mailing Address - Fax:
Practice Address - Street 1:2615 TURKEYFOOT RD
Practice Address - Street 2:
Practice Address - City:LAKESIDE PARK
Practice Address - State:KY
Practice Address - Zip Code:41017-2526
Practice Address - Country:US
Practice Address - Phone:859-426-5786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-06
Last Update Date:2009-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2977225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist