Provider Demographics
NPI:1619472990
Name:STEWART, ALYSSIA AMANDA (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSIA
Middle Name:AMANDA
Last Name:STEWART
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:MISS
Other - First Name:ALYSSIA
Other - Middle Name:AMANDA
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:107 STRONG RD
Mailing Address - Street 2:
Mailing Address - City:PENN RUN
Mailing Address - State:PA
Mailing Address - Zip Code:15765-7745
Mailing Address - Country:US
Mailing Address - Phone:724-464-8915
Mailing Address - Fax:
Practice Address - Street 1:107 STRONG RD
Practice Address - Street 2:
Practice Address - City:PENN RUN
Practice Address - State:PA
Practice Address - Zip Code:15765-7745
Practice Address - Country:US
Practice Address - Phone:724-464-8915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014001225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist