Provider Demographics
NPI:1487340873
Name:MCCLUTCHY, JORDAN NICOLE (OT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:NICOLE
Last Name:MCCLUTCHY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4707 140TH AVE N STE 313
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-3841
Mailing Address - Country:US
Mailing Address - Phone:727-223-8978
Mailing Address - Fax:727-303-3952
Practice Address - Street 1:4707 140TH AVE N STE 313
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3841
Practice Address - Country:US
Practice Address - Phone:727-223-8978
Practice Address - Fax:727-303-3952
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty