Healthcare Provider Details

I. General information

NPI: 1578474409
Provider Name (Legal Business Name): ALYSSA LENHARDT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 TAVERNIER DR STE B
PONTE VEDRA BEACH FL
32081-1270
US

IV. Provider business mailing address

171 SHETLAND DR
ST JOHNS FL
32259-6958
US

V. Phone/Fax

Practice location:
  • Phone: 904-404-2345
  • Fax:
Mailing address:
  • Phone: 913-938-2823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT27402
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: