Alissa Lynn Glezen, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OC013432 Issued in PA

Practice address

354 Main St
Forest City, PA 18421-1418

Phone

(570) 785-2018

Fax

(570) 785-3575

NPI assigned

Nov 4, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Alissa Lynn Richardson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1446595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452211200000",
    "number": "1700259405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "354 MAIN ST",
            "city": "FOREST CITY",
            "state": "PA",
            "postal_code": "184211418",
            "telephone_number": "570-785-2018",
            "fax_number": "570-785-3575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "354 MAIN ST",
            "city": "FOREST CITY",
            "state": "PA",
            "postal_code": "184211418",
            "telephone_number": "570-785-2018",
            "fax_number": "570-785-3575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLEZEN",
        "first_name": "ALISSA",
        "middle_name": "LYNN",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-04",
        "last_updated": "2016-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "PA",
            "license": "OC013432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103053753",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "003328901",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALISSA",
            "last_name": "RICHARDSON",
            "middle_name": "LYNN",
            "credential": "OTR/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• All providers in Forest City, PA
• Occupational Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.