Provider Demographics
NPI:1972989010
Name:GONZALEZ, ALYSSA WITTMANN (OTR/L)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:WITTMANN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8001 SW 36TH ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-1915
Mailing Address - Country:US
Mailing Address - Phone:954-577-7790
Mailing Address - Fax:954-577-7780
Practice Address - Street 1:556 N 1ST ST STE 201
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5300
Practice Address - Country:US
Practice Address - Phone:408-384-4993
Practice Address - Fax:408-856-1246
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22371225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist