Provider Demographics
NPI:1437508090
Name:DIPROFIO, ALYSSA LORRAINE (MSOT, R/L)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:LORRAINE
Last Name:DIPROFIO
Suffix:
Gender:F
Credentials:MSOT, R/L
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:LORRAINE
Other - Last Name:TALLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOT, R/L
Mailing Address - Street 1:3021 REGENTS TOWER ST APT 242
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-1276
Mailing Address - Country:US
Mailing Address - Phone:717-756-1583
Mailing Address - Fax:
Practice Address - Street 1:7001 HERITAGE VILLAGE PLZ STE 175
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3097
Practice Address - Country:US
Practice Address - Phone:703-291-1254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-05
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006948225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist