Provider Demographics
NPI:1427250240
Name:MCCARTHY, ALISA LYNN (OTRL)
Entity type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:LYNN
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6016 ANVIL AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-5334
Mailing Address - Country:US
Mailing Address - Phone:941-301-7332
Mailing Address - Fax:941-358-7950
Practice Address - Street 1:5255 OFFICE PARK BLVD STE 107
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-3443
Practice Address - Country:US
Practice Address - Phone:941-301-7332
Practice Address - Fax:941-358-7950
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9014174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist