Basic Information
Provider Information
NPI: 1033557582
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MUCHOW
FirstName: CLAIRE
MiddleName: DUVALL
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: SALISBURY
OtherFirstName: CLAIRE
OtherMiddleName: DUVALL
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 113 JOHNSTON BLVD
Address2:  
City: LEXINGTON
State: KY
PostalCode: 405032028
CountryCode: US
TelephoneNumber: 8592242273
FaxNumber:  
Practice Location
Address1: 113 JOHNSTON BLVD
Address2:  
City: LEXINGTON
State: KY
PostalCode: 405032028
CountryCode: US
TelephoneNumber: 9198013426
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/06/2013
LastUpdateDate: 11/17/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000XR5569KYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 
225X00000X  N Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 
225XP0200X114451TXN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics

ID Information
IDTypeStateIssuerDescription
710025324005KY MEDICAID


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