Provider Demographics
NPI:1124543855
Name:MARTIN, CLARISSA (OTR)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8915 RAMSEYER RD
Mailing Address - Street 2:
Mailing Address - City:EDCOUCH
Mailing Address - State:TX
Mailing Address - Zip Code:78538-3453
Mailing Address - Country:US
Mailing Address - Phone:956-457-8996
Mailing Address - Fax:
Practice Address - Street 1:8915 RAMSEYER RD
Practice Address - Street 2:
Practice Address - City:EDCOUCH
Practice Address - State:TX
Practice Address - Zip Code:78538-3453
Practice Address - Country:US
Practice Address - Phone:956-457-8996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13019533225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist