Provider Demographics
NPI:1083988562
Name:DRAEGER, ALYSSA EVE (LMT)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:EVE
Last Name:DRAEGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 W CAPITOL DR APT 13
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-1931
Mailing Address - Country:US
Mailing Address - Phone:262-352-0869
Mailing Address - Fax:
Practice Address - Street 1:114 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-2042
Practice Address - Country:US
Practice Address - Phone:262-352-0869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5083-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist