Provider Demographics
NPI:1093167983
Name:MOSACK, ALISSAH BRIANNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALISSAH
Middle Name:BRIANNE
Last Name:MOSACK
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 1:2513 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5851
Mailing Address - Country:US
Mailing Address - Phone:315-797-6241
Mailing Address - Fax:
Practice Address - Street 1:2513 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5851
Practice Address - Country:US
Practice Address - Phone:315-797-6241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist