Provider Demographics
NPI:1003889718
Name:STEPHENSON, ALYSSA LEE (ATC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LEE
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5477 VILLAGE GREEN CT
Mailing Address - Street 2:APT. C
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-4279
Mailing Address - Country:US
Mailing Address - Phone:515-570-9877
Mailing Address - Fax:
Practice Address - Street 1:5477 VILLAGE GREEN CT
Practice Address - Street 2:APT. C
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-4279
Practice Address - Country:US
Practice Address - Phone:515-570-9877
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program