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General NPI Number Information
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NPI Number | 1205460607
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Entity Type | Individual
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Provider Name | ALYSSA JOANNA MACDONALD OTR/L
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Gender | Female
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Dates
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Enumeration Date | 02/25/2020
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Last Update Date | 06/23/2021
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Provider Practice Location Address
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Address Line | 984 1/2 SABATTUS ST
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City | LEWISTON
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State | ME
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Zip | 04240-3333
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Country | US
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Telephone | 207-241-0157
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Fax | 207-753-3003
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Provider Business Mailing Address
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Address Line | 140 RALPH RICHARDSON RD
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City | NORWAY
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State | ME
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Zip | 04268-5049
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Country | US
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Telephone | 207-440-4508
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 433648
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License Number State | ME
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