Provider Demographics
NPI:1366115123
Name:MAHONEY, ALYSSA (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W MARYLAND LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MT
Mailing Address - Zip Code:59044-2041
Mailing Address - Country:US
Mailing Address - Phone:406-596-3105
Mailing Address - Fax:406-656-1713
Practice Address - Street 1:1780 SHILOH RD STE B
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-1736
Practice Address - Country:US
Practice Address - Phone:406-596-3105
Practice Address - Fax:406-656-1713
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8508225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics