Provider Demographics
NPI:1679060073
Name:QUARTUCCIO, ALYSSA (OTR/L)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:QUARTUCCIO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 COLDENHAM RD
Mailing Address - Street 2:
Mailing Address - City:WALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:12586-2908
Mailing Address - Country:US
Mailing Address - Phone:845-325-0904
Mailing Address - Fax:
Practice Address - Street 1:612 DEPEW STREET
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:21586
Practice Address - Country:US
Practice Address - Phone:914-739-0093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0220038-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist