Provider Demographics
NPI:1457559270
Name:CLARKE, DONNANNE MARY (OTR)
Entity Type:Individual
Prefix:
First Name:DONNANNE
Middle Name:MARY
Last Name:CLARKE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:DONNANNE
Other - Middle Name:MARY
Other - Last Name:GORELCZENKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:29 CAMEO DR
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-1914
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:365 BELDEN HILL RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06484-1914
Practice Address - Country:US
Practice Address - Phone:203-762-4149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1773225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist