Provider Demographics
NPI:1023467669
Name:OTERO, ALYSSA KAYLA
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:KAYLA
Last Name:OTERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-1707
Mailing Address - Country:US
Mailing Address - Phone:978-596-5370
Mailing Address - Fax:
Practice Address - Street 1:22 OLD CANAL DR
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-2730
Practice Address - Country:US
Practice Address - Phone:978-453-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-04
Last Update Date:2016-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program