Provider Demographics
NPI:1730557398
Name:CLIFFORD-WALTER, JACLYN BELL (OTR/L)
Entity type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:BELL
Last Name:CLIFFORD-WALTER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:JACLYN
Other - Middle Name:BELL
Other - Last Name:CLIFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:543 PROSPECT ST
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2135
Mailing Address - Country:US
Mailing Address - Phone:617-365-7557
Mailing Address - Fax:
Practice Address - Street 1:543 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2135
Practice Address - Country:US
Practice Address - Phone:617-365-7557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4466225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist