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General NPI Number Information
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NPI Number | 1538601612
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Entity Type | Individual
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Provider Name | ALYSSA WEGELIN MT-BC, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 11/07/2016
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Last Update Date | 02/08/2017
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Provider Practice Location Address
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Address Line | 1804 OAKLEY SEAVER DR STE E
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City | CLERMONT
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State | FL
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Zip | 34711-1925
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Country | US
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Telephone | 352-989-5838
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 LEXINGTON GREEN LN
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City | SANFORD
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State | FL
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Zip | 32771-1013
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Country | US
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Telephone | 407-688-0070
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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 | 18070
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License Number State | FL
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