Healthcare Provider Details

I. General information

NPI: 1013367689
Provider Name (Legal Business Name): ALYSSA CHRISTINE DODD MS, LAT, ATC, OTC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ALYSSA CHRISTINE MONAHAN

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 02/16/2023
Certification Date: 01/30/2023
Deactivation Date: 11/19/2019
Reactivation Date: 10/04/2022

III. Provider practice location address

15813 PAUL VEGA MD DR STE 100
HAMMOND LA
70403-1431
US

IV. Provider business mailing address

15813 PAUL VEGA MD DR STE 100
HAMMOND LA
70403-1431
US

V. Phone/Fax

Practice location:
  • Phone: 985-230-2663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number312204
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code246ZX2200X
TaxonomyOrthopedic Assistant
License Number22-1108
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: