Provider Demographics
NPI:1104512896
Name:ROGERS, CLARISSA (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 LIMERICK RD
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-2080
Mailing Address - Country:US
Mailing Address - Phone:956-463-3356
Mailing Address - Fax:
Practice Address - Street 1:2009 S WALNUT AVE STE 103
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2364
Practice Address - Country:US
Practice Address - Phone:830-507-1285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122180225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics