Provider Demographics
NPI:1073057238
Name:KNYSZ, ALANIE D (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALANIE
Middle Name:D
Last Name:KNYSZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:KINGSLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49649-9548
Mailing Address - Country:US
Mailing Address - Phone:231-263-1350
Mailing Address - Fax:231-263-1353
Practice Address - Street 1:4040 BEACON ST
Practice Address - Street 2:
Practice Address - City:KINGSLEY
Practice Address - State:MI
Practice Address - Zip Code:49649-9548
Practice Address - Country:US
Practice Address - Phone:231-263-1350
Practice Address - Fax:231-263-1353
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007585225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist