Healthcare Provider Details

I. General information

NPI: 1720906209
Provider Name (Legal Business Name): ALYSSA MCDERMOTT OTD/OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NATURE WALK PKWY STE 108101
SAINT AUGUSTINE FL
32092-5073
US

IV. Provider business mailing address

111 NATURE WALK PKWY STE 108101
SAINT AUGUSTINE FL
32092-5073
US

V. Phone/Fax

Practice location:
  • Phone: 904-328-7489
  • Fax: 904-490-8549
Mailing address:
  • Phone: 904-328-7489
  • Fax: 904-490-8549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number26370
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: