Provider Demographics
NPI:1467167304
Name:MORTIMER, ALYSON (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:MORTIMER
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 1:5409 65TH PL
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1659
Mailing Address - Country:US
Mailing Address - Phone:646-339-4312
Mailing Address - Fax:
Practice Address - Street 1:5409 65TH PL
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1659
Practice Address - Country:US
Practice Address - Phone:646-339-4312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021449225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist