Healthcare Provider Details

I. General information

NPI: 1265358428
Provider Name (Legal Business Name): ALYSSA LANDRY MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 ENERGY PKWY
LAFAYETTE LA
70508-3818
US

IV. Provider business mailing address

108 ENERGY PKWY
LAFAYETTE LA
70508-3818
US

V. Phone/Fax

Practice location:
  • Phone: 337-504-4244
  • Fax: 337-706-7612
Mailing address:
  • Phone: 337-504-4244
  • Fax: 337-706-7612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number353029
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: