Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mrs. Alyssa Rose Marie Formyduval, MS, OTR/L, CSRS

Individual provider Occupational Therapist · NPI 1891285748

Mrs. Alyssa Rose Marie Formyduval, MS, OTR/L, CSRS is an Occupational Therapist in East Chicago, Indiana. Licensed in Indiana. Registered with an NPI since 2018.

Licensed in
IN
In the registry since
2018
What do these letters mean?
MS — Master of Science
A graduate science degree.
OTR/L — Occupational Therapist, Registered and Licensed
An occupational therapist who is both nationally registered and state licensed.

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Practice location Address checks out

4321 Fir St
East Chicago, IN 46312-3097
Phone: (219) 392-7400
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Occupational Therapist (primary) Taxonomy 225X00000X · Licence 31005709A (IN)

Record details

NPI number1891285748
Entity typeIndividual (Type 1)
GenderFemale
Credentials MS , OTR/L , CSRS
Sole proprietorNo
NPI enumeratedMay 16, 2018
Last updated in NPPESMay 16, 2018

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