Provider Demographics
NPI:1821609975
Name:RESULTAY, ALLYSA MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALLYSA
Middle Name:MARIE
Last Name:RESULTAY
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 1:205 S SHIPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-5859
Mailing Address - Country:US
Mailing Address - Phone:626-513-5326
Mailing Address - Fax:
Practice Address - Street 1:471 W LAMBERT RD STE 106
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3921
Practice Address - Country:US
Practice Address - Phone:714-255-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21387225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist