Provider Demographics
NPI:1215201314
Name:SAUVAGEAU, ALYSSA LYNN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:LYNN
Last Name:SAUVAGEAU
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 1:207 MAIN AVE W
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-1725
Mailing Address - Country:US
Mailing Address - Phone:701-499-1022
Mailing Address - Fax:701-232-2330
Practice Address - Street 1:207 MAIN AVE W
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-1725
Practice Address - Country:US
Practice Address - Phone:701-499-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1218225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics