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General NPI Number Information
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NPI Number | 1962971895
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Entity Type | Individual
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Provider Name | ALYSSA JASMINE OTT MT-BC
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Gender | Female
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Dates
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Enumeration Date | 11/20/2018
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Last Update Date | 11/20/2018
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Provider Practice Location Address
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Address Line | 1350 E TOUHY AVE # 130
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City | DES PLAINES
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State | IL
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Zip | 60018-3303
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Country | US
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Telephone | 815-812-2355
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Fax |
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Provider Business Mailing Address
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Address Line | 4524 N WOLCOTT AVE APT 1A
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City | CHICAGO
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State | IL
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Zip | 60640-5240
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Country | US
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Telephone | 972-965-4366
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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 | 225A00000X
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Taxonomy Name | Music Therapist
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License Number | 13136
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License Number State |
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