Provider Demographics
NPI:1538609482
Name:PITTSBURGH OROFACIAL MYOFUNCTIONAL THERAPY, LLC
Entity type:Organization
Organization Name:PITTSBURGH OROFACIAL MYOFUNCTIONAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED OROFACIAL MYOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-407-2668
Mailing Address - Street 1:401 SHADY AVE # G-100
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-4409
Mailing Address - Country:US
Mailing Address - Phone:412-407-2668
Mailing Address - Fax:
Practice Address - Street 1:401 SHADY AVE # G-100
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-4409
Practice Address - Country:US
Practice Address - Phone:412-407-2668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-26
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH071760124Q00000X
174N00000X, 225700000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty