Provider Demographics
NPI:1114224516
Name:BAINTER, ALYSA NICOLE (OT)
Entity Type:Individual
Prefix:
First Name:ALYSA
Middle Name:NICOLE
Last Name:BAINTER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 W. WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62636
Mailing Address - Country:US
Mailing Address - Phone:217-285-4512
Mailing Address - Fax:217-285-5740
Practice Address - Street 1:128 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:IL
Practice Address - Zip Code:62363-1441
Practice Address - Country:US
Practice Address - Phone:217-285-4512
Practice Address - Fax:217-285-5740
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation