Provider Demographics
NPI:1932246139
Name:OLIVER, ALYSSA ANN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:ANN
Last Name:OLIVER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MALER LN
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3558
Mailing Address - Country:US
Mailing Address - Phone:631-987-4563
Mailing Address - Fax:631-456-5879
Practice Address - Street 1:75 MALER LN
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-987-4563
Practice Address - Fax:631-456-5879
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0133351-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics