Provider Demographics
NPI:1477196616
Name:CABALLERO, CLARISSA CHELSEA (COTA)
Entity Type:Individual
Prefix:MS
First Name:CLARISSA
Middle Name:CHELSEA
Last Name:CABALLERO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 LARGO ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-9113
Mailing Address - Country:US
Mailing Address - Phone:956-246-1916
Mailing Address - Fax:
Practice Address - Street 1:711 W NOLANA AVE STE 204A
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3079
Practice Address - Country:US
Practice Address - Phone:956-803-0033
Practice Address - Fax:956-683-6448
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215947224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant