Provider Demographics
NPI:1801223664
Name:THANADABOUTH, ALYSSA (MS OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:
Last Name:THANADABOUTH
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:MISS
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:PARDINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR/L
Mailing Address - Street 1:150 CAFARO CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1038
Mailing Address - Country:US
Mailing Address - Phone:209-607-8927
Mailing Address - Fax:
Practice Address - Street 1:2115 J ST
Practice Address - Street 2:STE 210
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4738
Practice Address - Country:US
Practice Address - Phone:916-444-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13731225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist