Healthcare Provider Details

I. General information

NPI: 1629596341
Provider Name (Legal Business Name): JO ANN MCCLAIN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JO ANN MONGRAIN

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7822 ANDERSONVILLE RD
CLARKSTON MI
48346-2573
US

IV. Provider business mailing address

1311 MAMARONECK AVE STE 140
WHITE PLAINS NY
10605-5224
US

V. Phone/Fax

Practice location:
  • Phone: 248-707-3100
  • Fax:
Mailing address:
  • Phone: 914-294-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201009903
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: