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General NPI Number Information
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NPI Number | 1275010936
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Entity Type | Individual
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Provider Name | ALYSSA BOARDWAY
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Gender | Female
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Dates
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Enumeration Date | 07/25/2018
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Last Update Date | 07/25/2018
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Provider Practice Location Address
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Address Line | 642 METACOM AVE
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City | WARREN
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State | RI
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Zip | 02885-2350
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Country | US
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Telephone | 401-245-2860
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Fax |
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Provider Business Mailing Address
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Address Line | 374 LLOYD AVE APT 10
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City | PROVIDENCE
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State | RI
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Zip | 02906-4261
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Country | US
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Telephone | 413-313-6170
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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 | OT01732
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License Number State | RI
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