Provider Demographics
NPI:1407102841
Name:EGAN, ALYSIA (ATC, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ALYSIA
Middle Name:
Last Name:EGAN
Suffix:
Gender:F
Credentials:ATC, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7122
Mailing Address - Country:US
Mailing Address - Phone:732-674-7115
Mailing Address - Fax:
Practice Address - Street 1:14 BRIDGEWATERS DR
Practice Address - Street 2:
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-1162
Practice Address - Country:US
Practice Address - Phone:732-542-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00590100225XP0200X
NJ225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics