Provider Demographics
NPI:1184003485
Name:JOHNSON, ALYSSA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:GAJEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:506 REID DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-1885
Mailing Address - Country:US
Mailing Address - Phone:608-622-6846
Mailing Address - Fax:
Practice Address - Street 1:506 REID DR
Practice Address - Street 2:
Practice Address - City:MOUNT HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572-1885
Practice Address - Country:US
Practice Address - Phone:608-622-6846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5677-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist