Healthcare Provider Details

I. General information

NPI: 1457915506
Provider Name (Legal Business Name): ALYSSA S MORAVEC OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MANTENO IL
60950-9466
US

IV. Provider business mailing address

16642 CHARNSWOOD CT
TINLEY PARK IL
60477-6800
US

V. Phone/Fax

Practice location:
  • Phone: 815-468-6581
  • Fax:
Mailing address:
  • Phone: 708-699-5394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056012982
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: