Provider Demographics
NPI:1689486441
Name:CLIFFORD, JOANNE (COTA)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6273 TAMPA RIVER PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-1721
Mailing Address - Country:US
Mailing Address - Phone:915-777-0047
Mailing Address - Fax:
Practice Address - Street 1:5400 SUNCREST DR STE D1
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5615
Practice Address - Country:US
Practice Address - Phone:915-343-5099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215083224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant