Provider Demographics
NPI:1023565272
Name:NAGLE, ALYSSA M (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:M
Last Name:NAGLE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:M
Other - Last Name:SAJDAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:700 COTTAGE BROOK LN
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-8654
Mailing Address - Country:US
Mailing Address - Phone:585-797-9366
Mailing Address - Fax:
Practice Address - Street 1:700 COTTAGE BROOK LN
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-8654
Practice Address - Country:US
Practice Address - Phone:585-797-9366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020835-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist