Provider Demographics
NPI:1013485309
Name:VERRON, ALYSSA (OTR/L)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:VERRON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:MANGIERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:4 BOULEVARD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-1215
Mailing Address - Country:US
Mailing Address - Phone:631-835-0058
Mailing Address - Fax:
Practice Address - Street 1:75 PERKAL ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6642
Practice Address - Country:US
Practice Address - Phone:631-968-1252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022817225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist