Healthcare Provider Details

I. General information

NPI: 1265355408
Provider Name (Legal Business Name): ALYSSA BROOKE ECKSTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2028 LIBERTY RD STE 103
ELDERSBURG MD
21784-5079
US

IV. Provider business mailing address

12206 STATEWOOD RD
REISTERSTOWN MD
21136-4720
US

V. Phone/Fax

Practice location:
  • Phone: 240-200-4010
  • Fax:
Mailing address:
  • Phone: 443-814-3704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10810
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: