Individual
MRS. ALYSSA ROSE MARIE FORMYDUVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, OTR/L, CSRS
Contact information
Practice address
4321 FIR ST, EAST CHICAGO, IN 46312-3097
(219) 392-7400
Mailing address
4321 FIR ST, EAST CHICAGO, IN 46312-3097
(219) 392-7400
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31005709A
IN
Other
Enumeration date
05/16/2018
Last updated
05/16/2018
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