Provider Demographics
NPI:1477083558
Name:OUELLETTE, ALYSSA BEVERLY
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:BEVERLY
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 KIRTS BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4888
Mailing Address - Country:US
Mailing Address - Phone:248-918-5560
Mailing Address - Fax:
Practice Address - Street 1:1282 KIRTS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4888
Practice Address - Country:US
Practice Address - Phone:248-918-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201011211225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist