Provider Demographics
NPI:1942626999
Name:BOUR, CLAIRE (OTR)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:BOUR
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:
Other - Last Name:SCHOENIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:80 PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-5152
Mailing Address - Country:US
Mailing Address - Phone:765-448-1758
Mailing Address - Fax:
Practice Address - Street 1:80 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5152
Practice Address - Country:US
Practice Address - Phone:765-448-1758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005620A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201220010Medicaid