Healthcare Provider Details

I. General information

NPI: 1194489377
Provider Name (Legal Business Name): AMBER CLUKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 N DEER ISLE RD
DEER ISLE ME
04627-3438
US

IV. Provider business mailing address

1 STILES RD STE 203
SALEM NH
03079-4804
US

V. Phone/Fax

Practice location:
  • Phone: 855-390-7774
  • Fax: 855-734-4666
Mailing address:
  • Phone: 855-390-7774
  • Fax: 855-734-4666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberTO4188
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: