Provider Demographics
NPI:1841996238
Name:MENDEZ, CLARISSA JOANN (OTR/L)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:JOANN
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23720 PLEASANT VIEW LN
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20882-2802
Mailing Address - Country:US
Mailing Address - Phone:240-644-4198
Mailing Address - Fax:
Practice Address - Street 1:6710 MALLERY DR
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3964
Practice Address - Country:US
Practice Address - Phone:301-552-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09817225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist