Provider Demographics
NPI:1487192811
Name:MCCLUSKEY, DELLA M (COTA)
Entity type:Individual
Prefix:
First Name:DELLA
Middle Name:M
Last Name:MCCLUSKEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:DELLA
Other - Middle Name:M
Other - Last Name:MCCLUSKEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:314 COUNTY ROAD 472
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454-7519
Mailing Address - Country:US
Mailing Address - Phone:870-598-7359
Mailing Address - Fax:
Practice Address - Street 1:148 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4077
Practice Address - Country:US
Practice Address - Phone:870-219-1086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1164224Z00000X
MO2016034140224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant