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NPI Code Detail

MEDICARE: ALYSSA SMITH IRVING OTR/L

MEDICARE: ALYSSA SMITH IRVING OTR/L
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
1225X00000XOccupational TherapistOC016115PA

General Provider Information

NPI Number : 1669937306
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSSA SMITH IRVING OTR/L
Provider Business Mailing Address
First Line : 220 REED ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19147-6037
Country : US
Telephone Number : 215-876-5169
Fax Number :
Provider Business Practice Location Address
First Line : 6401 MARTINS MILL RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19111-5304
Country : US
Telephone Number : 215-490-9903
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2019
Last Update Date : 02/06/2019

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