Provider Demographics
NPI:1477506269
Name:KOCIAN, ALISA N (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:N
Last Name:KOCIAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 CURVE CREST BLVD
Mailing Address - Street 2:COURAGE CENTER
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082
Mailing Address - Country:US
Mailing Address - Phone:651-351-3368
Mailing Address - Fax:651-351-3383
Practice Address - Street 1:1460 CURVE CREST BLVD
Practice Address - Street 2:COURAGE CENTER
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082
Practice Address - Country:US
Practice Address - Phone:651-351-2341
Practice Address - Fax:651-439-8283
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102904225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP49567OtherHEALTHPARTNERS
MN64-05273OtherMEDICA
MN476R5KOOtherBCBS-MINNESOTA