Provider Demographics
NPI:1194204198
Name:TAMA, ALYSSA DENISE (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:DENISE
Last Name:TAMA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 SWAGGERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-3714
Mailing Address - Country:US
Mailing Address - Phone:518-496-1956
Mailing Address - Fax:
Practice Address - Street 1:1 RAPP RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-4491
Practice Address - Country:US
Practice Address - Phone:518-867-3066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2024-01-29
Deactivation Date:2024-01-10
Deactivation Code:
Reactivation Date:2024-01-29
Provider Licenses
StateLicense IDTaxonomies
NY009811-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant