Healthcare Provider Details

I. General information

NPI: 1588119648
Provider Name (Legal Business Name): ALYSSA GELB-HILLIARD OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5044 MAYFIELD RD
LYNDHURST OH
44124-2605
US

IV. Provider business mailing address

1658 CHESTNUT TRAIL DR
TWINSBURG OH
44087-2826
US

V. Phone/Fax

Practice location:
  • Phone: 216-691-2000
  • Fax:
Mailing address:
  • Phone: 216-990-8598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT-04311
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: