Individual
ALYSSA SHAY MCKENNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1201 HOLLAND LAKE DR, WEATHERFORD, TX 76086-5851
(817) 598-0160
Mailing address
235 RAMSEY RD, SANTO, TX 76472-2426
(940) 329-8496
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
215290
TX
Other
Enumeration date
08/16/2018
Last updated
08/16/2018
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