MEDICARE: ALYSSA GALLARDO-GUEVARA OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1407634397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA GALLARDO-GUEVARA OT

Provider Business Mailing Address
First Line	:	6005 HIGH PLAINS RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-7090
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6005 HIGH PLAINS RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-7090
Country	:	US
Telephone Number	:	575-590-5846
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2023
Last Update Date	:	06/22/2026

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