Provider Demographics
NPI:1518049113
Name:KEEGAN, ALYSSA VICTORIA (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:VICTORIA
Last Name:KEEGAN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MISS
Other - First Name:ALYSSA
Other - Middle Name:VICTORIA
Other - Last Name:PORTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 KINGSLEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:GANSEVOORT
Mailing Address - State:NY
Mailing Address - Zip Code:12831
Mailing Address - Country:US
Mailing Address - Phone:518-695-9408
Mailing Address - Fax:
Practice Address - Street 1:16 SARATOGA BRIDGES BLVD
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020
Practice Address - Country:US
Practice Address - Phone:518-587-5747
Practice Address - Fax:518-583-9607
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011563225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist