Provider Demographics
NPI:1184046120
Name:DENNIE, ALISSA (OT)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:DENNIE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:
Other - Last Name:HERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:715 CONGRESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4044
Mailing Address - Country:US
Mailing Address - Phone:513-802-1929
Mailing Address - Fax:889-727-3498
Practice Address - Street 1:715 CONGRESS PARK DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4044
Practice Address - Country:US
Practice Address - Phone:513-802-1929
Practice Address - Fax:889-727-3498
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH008503225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2187155Medicaid
OH2187155Medicaid