Provider Demographics
NPI:1639841679
Name:PERCIVAL, ALISSA A (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:A
Last Name:PERCIVAL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 JEFFREY LN
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1405
Mailing Address - Country:US
Mailing Address - Phone:908-635-7882
Mailing Address - Fax:
Practice Address - Street 1:3325 POCAHONTAS RD
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-1464
Practice Address - Country:US
Practice Address - Phone:541-523-6461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist