Individual
ALYSSA MERRILL VAN WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
3186 S 2550 W, SYRACUSE, UT 84075-4911
(435) 890-0560
Mailing address
3186 S 2550 W, SYRACUSE, UT 84075-4911
(435) 890-0560
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
12872355-4201
UT
Other
Enumeration date
07/06/2022
Last updated
02/12/2026
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