Provider Demographics
NPI:1225477128
Name:DECICCO, ALYSSA LYN
Entity Type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:LYN
Last Name:DECICCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GRACEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-8785
Mailing Address - Country:US
Mailing Address - Phone:610-746-1908
Mailing Address - Fax:610-746-1992
Practice Address - Street 1:2 GRACEDALE AVE
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-8785
Practice Address - Country:US
Practice Address - Phone:610-746-1908
Practice Address - Fax:610-746-1992
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATOC102656225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist