Healthcare Provider Details

I. General information

NPI: 1093199002
Provider Name (Legal Business Name): ALYSSA DESILETS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8881 N SEYMOUR AVE APT 103
KANSAS CITY MO
64153-2076
US

IV. Provider business mailing address

8881 N SEYMOUR AVE APT 103
KANSAS CITY MO
64153-2076
US

V. Phone/Fax

Practice location:
  • Phone: 413-244-9293
  • Fax:
Mailing address:
  • Phone: 413-244-9293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2015015940
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: