Provider Demographics
NPI:1588316525
Name:CLARK, ALECIA RATTIGAN (OTR)
Entity type:Individual
Prefix:MRS
First Name:ALECIA
Middle Name:RATTIGAN
Last Name:CLARK
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 1:5610 THUNDER OAKS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2490
Mailing Address - Country:US
Mailing Address - Phone:843-906-8007
Mailing Address - Fax:
Practice Address - Street 1:575 KNIGHTS CROSS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3342
Practice Address - Country:US
Practice Address - Phone:210-404-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120871225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist