Basic Information
| Provider Information | |||||||||
| NPI: | 1306427695 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLAVER | ||||||||
| FirstName: | CLARISE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 FAIRVIEW DR | ||||||||
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| City: | BROCKPORT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144202615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857383911 | ||||||||
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| Practice Location | |||||||||
| Address1: | 590 FISHERS STATION DR STE 130 | ||||||||
| Address2: | |||||||||
| City: | VICTOR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145649744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859247207 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2021 | ||||||||
| LastUpdateDate: | 01/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 017059 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.