Provider Demographics
NPI:1144763715
Name:MOFFITT, ALYSSA LEE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:LEE
Last Name:MOFFITT
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 1:901 CYPRESS CREEK RD
Mailing Address - Street 2:#102
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3998
Mailing Address - Country:US
Mailing Address - Phone:512-551-5590
Mailing Address - Fax:
Practice Address - Street 1:901 CYPRESS CREEK RD
Practice Address - Street 2:#102
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3998
Practice Address - Country:US
Practice Address - Phone:512-551-5590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112405225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist