MEDICARE: ALYSSA DESILETS OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	2015015940	MO

General Provider Information

NPI Number	:	1093199002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA DESILETS OTR/L

Provider Business Mailing Address
First Line	:	8881 N SEYMOUR AVE APT 103
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64153-2076
Country	:	US
Telephone Number	:	413-244-9293
Fax Number	:

Provider Business Practice Location Address
First Line	:	8881 N SEYMOUR AVE APT 103
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64153-2076
Country	:	US
Telephone Number	:	413-244-9293
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2015
Last Update Date	:	07/20/2015

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Directions to “ ALYSSA DESILETS OTR/L” Practice Location

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