Provider Demographics
NPI:1336824358
Name:BRAZELL, ALYSSA MARIE (OTR)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARIE
Last Name:BRAZELL
Suffix:
Gender:
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11751 ALTA VISTA RD STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6442
Mailing Address - Country:US
Mailing Address - Phone:817-562-1006
Mailing Address - Fax:817-562-1009
Practice Address - Street 1:11751 ALTA VISTA RD STE 201
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6442
Practice Address - Country:US
Practice Address - Phone:817-562-1006
Practice Address - Fax:817-562-1009
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0200X
TX493926225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics