Provider Demographics
NPI:1629416441
Name:FREY, ALYSSA JILL (OT)
Entity Type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:JILL
Last Name:FREY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BROADVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3611
Mailing Address - Country:US
Mailing Address - Phone:917-538-8850
Mailing Address - Fax:973-762-3892
Practice Address - Street 1:11 BROADVIEW AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3611
Practice Address - Country:US
Practice Address - Phone:917-538-8850
Practice Address - Fax:973-762-3892
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00382600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist