Provider Demographics
NPI:1205460607
Name:MACDONALD, ALYSSA JOANNA (OTR/L)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JOANNA
Last Name:MACDONALD
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 1:140 RALPH RICHARDSON RD
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-5049
Mailing Address - Country:US
Mailing Address - Phone:207-440-4508
Mailing Address - Fax:
Practice Address - Street 1:984 1/2 SABATTUS ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-3333
Practice Address - Country:US
Practice Address - Phone:207-241-0157
Practice Address - Fax:207-753-3003
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME433648225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist