Provider Demographics
NPI:1275835969
Name:SHEA, ALYSSA V (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:V
Last Name:SHEA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:16405 NORTHCROSS DR
Mailing Address - Street 2:SUITE G-2
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5091
Mailing Address - Country:US
Mailing Address - Phone:704-439-3406
Mailing Address - Fax:
Practice Address - Street 1:204 WYANDANCH RD
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2225
Practice Address - Country:US
Practice Address - Phone:631-241-3780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3754225X00000X
NY017190225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist