Provider Demographics
NPI:1639652571
Name:GAVIN, ALYSSA KATHALEEN (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:KATHALEEN
Last Name:GAVIN
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 ROCK ST APT H7
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3770
Mailing Address - Country:US
Mailing Address - Phone:484-680-8390
Mailing Address - Fax:
Practice Address - Street 1:209 ROCK ST APT H7
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-3770
Practice Address - Country:US
Practice Address - Phone:484-680-8390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015349225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics