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General NPI Number Information
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NPI Number | 1235793712
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Entity Type | Individual
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Provider Name | CARISSA CLAYTON OTR
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Gender | Female
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Dates
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Enumeration Date | 04/30/2019
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Last Update Date | 04/30/2019
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Provider Practice Location Address
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Address Line | 166 PATTERSON AVE
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City | SHREWSBURY
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State | NJ
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Zip | 07702-4176
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Country | US
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Telephone | 732-842-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 63 DES MOINES CT
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City | TINTON FALLS
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State | NJ
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Zip | 07712-7723
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Country | US
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Telephone | 908-433-4055
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 46TR00870200
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License Number State | NJ
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