Provider Demographics
NPI:1306176821
Name:MATECHAK, ALISSA LYNNE (COTA)
Entity type:Individual
Prefix:MISS
First Name:ALISSA
Middle Name:LYNNE
Last Name:MATECHAK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24 ELIAS RD
Mailing Address - Street 2:
Mailing Address - City:SPRING BROOK TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18444-6238
Mailing Address - Country:US
Mailing Address - Phone:570-842-9436
Mailing Address - Fax:
Practice Address - Street 1:956 E RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3831
Practice Address - Country:US
Practice Address - Phone:610-525-8412
Practice Address - Fax:610-527-4236
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP005973224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant