Provider Demographics
NPI:1063109163
Name:CAMARGO, ALYSSA MISCHELLE (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MISCHELLE
Last Name:CAMARGO
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 E COVINA HILLS RD
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3623
Mailing Address - Country:US
Mailing Address - Phone:626-484-9584
Mailing Address - Fax:
Practice Address - Street 1:4061 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1061
Practice Address - Country:US
Practice Address - Phone:323-737-2467
Practice Address - Fax:323-737-2422
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT22324225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist