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General NPI Number Information
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NPI Number | 1295325850
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Entity Type | Individual
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Provider Name | ALYSSA DETOMMASO OT
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Gender | Female
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Dates
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Enumeration Date | 01/19/2021
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 1330 WILLOW AVE APT 606
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City | HOBOKEN
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State | NJ
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Zip | 07030-3370
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Country | US
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Telephone | 201-956-0784
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Fax |
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Provider Business Mailing Address
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Address Line | 718 TEANECK RD
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City | TEANECK
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State | NJ
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Zip | 07666-4245
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Country | US
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Telephone | 201-833-3085
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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 | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | 46TR00807400
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License Number State | NJ
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