Provider Demographics
NPI:1730334194
Name:HITCHON, CLARISSA (OTR/L)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:HITCHON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 5TH AVE
Mailing Address - Street 2:2 R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3373
Mailing Address - Country:US
Mailing Address - Phone:731-394-7232
Mailing Address - Fax:
Practice Address - Street 1:1049 38TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-1012
Practice Address - Country:US
Practice Address - Phone:718-633-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014521-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist