Provider Demographics
NPI:1730158619
Name:STOVER, ALYSON D'AMBROSIO (JD, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ALYSON
Middle Name:D'AMBROSIO
Last Name:STOVER
Suffix:
Gender:F
Credentials:JD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 N HERMITAGE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3342
Mailing Address - Country:US
Mailing Address - Phone:724-342-3898
Mailing Address - Fax:
Practice Address - Street 1:499 N HERMITAGE RD
Practice Address - Street 2:SUITE B
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3342
Practice Address - Country:US
Practice Address - Phone:724-342-3898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5929225X00000X
PAOC010666225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102382990 0002Medicaid
NC7301895Medicaid