Healthcare Provider Details

I. General information

NPI: 1174159909
Provider Name (Legal Business Name): ALYSSA KATHLEEN PATTISON MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 MAIN ST STE 311
PLYMOUTH NH
03264-1500
US

IV. Provider business mailing address

20 BROADWAY # 2
CONCORD NH
03301-2845
US

V. Phone/Fax

Practice location:
  • Phone: 603-481-0055
  • Fax:
Mailing address:
  • Phone: 860-681-5401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2890
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: