Provider Demographics
NPI:1356716294
Name:RUDOLPH, CLAIRE ELLEN (MSOT)
Entity type:Individual
Prefix:MRS
First Name:CLAIRE
Middle Name:ELLEN
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:MS
Other - First Name:CLAIRE
Other - Middle Name:ELLEN
Other - Last Name:VAN VALEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:59 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-4405
Mailing Address - Country:US
Mailing Address - Phone:203-210-7124
Mailing Address - Fax:203-210-7126
Practice Address - Street 1:59 DANBURY RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4405
Practice Address - Country:US
Practice Address - Phone:203-210-7124
Practice Address - Fax:203-210-7126
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4518225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist