Provider Demographics
NPI:1619546769
Name:CONTRINO, MARISSA ANGELICA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:ANGELICA
Last Name:CONTRINO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:ANGELICA
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:8327 TIMBER BASIN ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-4437
Mailing Address - Country:US
Mailing Address - Phone:210-471-8698
Mailing Address - Fax:
Practice Address - Street 1:2011 BROADWAY ST STE 130
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5945
Practice Address - Country:US
Practice Address - Phone:832-241-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124304225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist