Healthcare Provider Details

I. General information

NPI: 1164343232
Provider Name (Legal Business Name): ALYSSA LAST OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3770 8TH ST SW
ALTOONA IA
50009-1048
US

IV. Provider business mailing address

3770 8TH ST SW
ALTOONA IA
50009-1048
US

V. Phone/Fax

Practice location:
  • Phone: 515-416-9380
  • Fax:
Mailing address:
  • Phone: 515-416-9380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number139746
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: