Active NPI
Alissa Gandiaga
- Occupational Therapist
- Avon, CT
National Provider Identifier
1316608771
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 005844
- Practice address
- 652 W Avon Rd
Avon, CT 06001-2906 - Phone
- (860) 673-2521
- NPI assigned
- Jan 6, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 005844 | CT | Primary |
Addresses
Primary practice location
652 W Avon Rd
Avon, CT 06001-2906
Mailing address
245 Great Swamp Rd
Glastonbury, CT 06033-1321
Phone (860) 874-2280
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 005844 | CT | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1641427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641427200000",
"number": "1316608771",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "245 GREAT SWAMP RD",
"city": "GLASTONBURY",
"state": "CT",
"postal_code": "060331321",
"telephone_number": "860-874-2280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "652 W AVON RD",
"city": "AVON",
"state": "CT",
"postal_code": "060012906",
"telephone_number": "860-673-2521"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANDIAGA",
"first_name": "ALISSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-01-06",
"last_updated": "2022-01-06",
"certification_date": "2022-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CT",
"license": "005844",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Avon, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.