Provider Demographics
NPI:1255916284
Name:LIWANAG, ALYSSA MARIZ LALIC (MA, OTR/L)
Entity type:Individual
Prefix:
First Name:ALYSSA MARIZ
Middle Name:LALIC
Last Name:LIWANAG
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 81ST ST APT 5C
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-5071
Mailing Address - Country:US
Mailing Address - Phone:646-384-6271
Mailing Address - Fax:
Practice Address - Street 1:3521 81ST ST APT 5C
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-5071
Practice Address - Country:US
Practice Address - Phone:646-384-6271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty