Provider Demographics
NPI:1770256935
Name:DUMPHY, ALYSSA RAE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:RAE
Last Name:DUMPHY
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 1:46 LADYSLIPPER LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-1083
Mailing Address - Country:US
Mailing Address - Phone:860-810-3110
Mailing Address - Fax:
Practice Address - Street 1:505 WILLARD AVE STE 1D
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2630
Practice Address - Country:US
Practice Address - Phone:860-665-8265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-25
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5382225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist