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General NPI Number Information
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NPI Number | 1316472111
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Entity Type | Individual
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Provider Name | ALYSSA CONCHA-CHAVEZ OTD, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 04/29/2017
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 3853 E DAHLIA DR
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City | PHOENIX
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State | AZ
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Zip | 85032-7341
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Country | US
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Telephone | 469-450-6338
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Fax |
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Provider Business Mailing Address
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Address Line | 3853 E DAHLIA DR
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City | PHOENIX
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State | AZ
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Zip | 85032-7341
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Country | US
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Telephone | 469-450-6338
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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 | 15111
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 118331
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 3710
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 7153
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License Number State | AZ
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