Provider Demographics
NPI:1619229499
Name:BRAGDON, ALYSSA LYNN (MS OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:LYNN
Last Name:BRAGDON
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 DURHAM BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04953-3626
Mailing Address - Country:US
Mailing Address - Phone:207-735-5770
Mailing Address - Fax:
Practice Address - Street 1:182 MOOSEHEAD TRL
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:ME
Practice Address - Zip Code:04953-4021
Practice Address - Country:US
Practice Address - Phone:207-368-5091
Practice Address - Fax:207-368-2192
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2683225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist