Provider Demographics
NPI:1699359968
Name:CULICERTO, ALYSSA ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ANN
Last Name:CULICERTO
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 1:1778 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-2278
Mailing Address - Country:US
Mailing Address - Phone:130-422-2332
Mailing Address - Fax:
Practice Address - Street 1:1778 SMITH RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314-2278
Practice Address - Country:US
Practice Address - Phone:130-422-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1549225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist