Provider Demographics
NPI:1366276297
Name:CLOUGH, JULIE (OTR/L)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:CLOUGH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 LAFAYETTE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5975
Mailing Address - Country:US
Mailing Address - Phone:603-373-8467
Mailing Address - Fax:
Practice Address - Street 1:2425 LAFAYETTE RD STE 2
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5975
Practice Address - Country:US
Practice Address - Phone:603-373-8467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1446225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist