Provider Demographics
NPI:1518413111
Name:MAUKE, JACLYNN ANN
Entity type:Individual
Prefix:MRS
First Name:JACLYNN
Middle Name:ANN
Last Name:MAUKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACLYNN
Other - Middle Name:ANN
Other - Last Name:MALONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:54 MAIN STREET
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01262-0938
Mailing Address - Country:US
Mailing Address - Phone:413-298-4401
Mailing Address - Fax:
Practice Address - Street 1:151 CHRISTIAN HILL RD
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1108
Practice Address - Country:US
Practice Address - Phone:413-528-4560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10974225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist