MEDICARE: ALYSSA N WYNN

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	224Z00000X	Occupational Therapy Assistant	OT-A1709	AR

General Provider Information

NPI Number	:	1912831470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA N WYNN

Provider Business Mailing Address
First Line	:	35 DONNA DR
Second Line	:
City	:	SHERIDAN
State	:	AR
Zip	:	72150-7047
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 DONNA DR
Second Line	:
City	:	SHERIDAN
State	:	AR
Zip	:	72150-7047
Country	:	US
Telephone Number	:	501-286-5056
Fax Number	:

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

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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Directions to “ ALYSSA N WYNN ” Practice Location

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