Provider Demographics
NPI:1235793712
Name:CLAYTON, CARISSA (OTR)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:CLAYTON
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 1:63 DES MOINES CT
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-7723
Mailing Address - Country:US
Mailing Address - Phone:908-433-4055
Mailing Address - Fax:
Practice Address - Street 1:166 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4176
Practice Address - Country:US
Practice Address - Phone:732-842-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00870200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist