Individual
MRS. ALISA DOMINIQUE FOSMIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
750 E ADAMS ST, SYRACUSE, NY 13210-2306
(315) 464-2302
Mailing address
8848 MIDLAKE MEADOWS DR, BRIDGEPORT, NY 13030-9726
(520) 309-5946
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
024168
NY
Other
Enumeration date
10/28/2019
Last updated
10/28/2019
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