Provider Demographics
NPI:1457103442
Name:ESPINOSA, ALYSSA JEAN (MSOT)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JEAN
Last Name:ESPINOSA
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MAYNARD ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1405
Mailing Address - Country:US
Mailing Address - Phone:860-455-8292
Mailing Address - Fax:
Practice Address - Street 1:100 MILK ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-4662
Practice Address - Country:US
Practice Address - Phone:978-685-0659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15262225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics