Healthcare Provider Details

I. General information

NPI: 1770200073
Provider Name (Legal Business Name): ALISON ELIZABETH GRYGO COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BLANDING AVE
ALAMEDA CA
94501-1503
US

IV. Provider business mailing address

29516 E HARBOR DR
MILLSBORO DE
19966-6855
US

V. Phone/Fax

Practice location:
  • Phone: 510-522-1084
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5731
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: