Provider Demographics
NPI:1003649443
Name:ROMAN, ALYSSA PAIGE (OTR/L)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:PAIGE
Last Name:ROMAN
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 1:111 KEVIN LN
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-9115
Mailing Address - Country:US
Mailing Address - Phone:630-915-2988
Mailing Address - Fax:
Practice Address - Street 1:4040 CANNONBALL TRL
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-4761
Practice Address - Country:US
Practice Address - Phone:630-381-0201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist