MEDICARE: AUTUMN DAWN CLEGG OTR, CBIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	112913	TX

General Provider Information

NPI Number	:	1164660387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN DAWN CLEGG OTR, CBIS

Provider Business Mailing Address
First Line	:	8300 FLOYD CURL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3931
Country	:	US
Telephone Number	:	210-450-9700
Fax Number	:	210-450-6039

Provider Business Practice Location Address
First Line	:	8300 FLOYD CURL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3931
Country	:	US
Telephone Number	:	210-450-9700
Fax Number	:	210-450-6039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2009
Last Update Date	:	02/04/2026

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