Individual
JENNIFER JOAN CLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1000 PALM AVE, MATTOON, IL 61938-6031
(217) 278-9817
Mailing address
2816 CHAMPAIGN AVE, MATTOON, IL 61938-2451
(217) 278-9817
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.002633
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057.002633
ILLINOIS DEPARTMENT OF REGULATION
IL
01
—
1075202
NATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY
—
Enumeration date
04/05/2021
Last updated
04/05/2021
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