MEDICARE: ALYSSA WATERS OTD, 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
1	225X00000X	Occupational Therapist	OT009207	GA

General Provider Information

NPI Number	:	1730925223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA WATERS OTD, OTR/L

Provider Business Mailing Address
First Line	:	1082 PARK ROW NORTH SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-3884
Country	:	US
Telephone Number	:	478-244-4237
Fax Number	:

Provider Business Practice Location Address
First Line	:	1082 PARK ROW NORTH SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-3884
Country	:	US
Telephone Number	:	478-244-4237
Fax Number	:

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

Provider Enumeration Date	:	07/03/2024
Last Update Date	:	02/23/2026

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