Provider Demographics
NPI:1164212312
Name:SAN JUAN, CLARISSA (OTR)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:SAN JUAN
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 1:12523 ELEMINA TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4561
Mailing Address - Country:US
Mailing Address - Phone:832-531-5487
Mailing Address - Fax:
Practice Address - Street 1:18 SCENIC LOOP RD # 200D
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-8672
Practice Address - Country:US
Practice Address - Phone:830-755-0098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-10
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116278225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist