Provider Demographics
NPI:1063241115
Name:MASSINGILL, ALYSON DEANNE (OTR)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:DEANNE
Last Name:MASSINGILL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PALOMINO PONY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-6380
Mailing Address - Country:US
Mailing Address - Phone:210-294-0742
Mailing Address - Fax:
Practice Address - Street 1:8823 PALOMINO PONY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-6380
Practice Address - Country:US
Practice Address - Phone:210-294-0742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109943225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist