Provider Demographics
NPI:1346933124
Name:ADAMO, ALYSE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALYSE
Middle Name:
Last Name:ADAMO
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 1:152 IMPATIENS CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-1332
Mailing Address - Country:US
Mailing Address - Phone:973-908-0886
Mailing Address - Fax:
Practice Address - Street 1:10 W END CT
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-5172
Practice Address - Country:US
Practice Address - Phone:732-222-2219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01055600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist