Provider Demographics
NPI:1548565500
Name:BOUWENS, ALYSSA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:BOUWENS
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 1:566 BLAKE HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03256-4423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:72 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NH
Practice Address - Zip Code:03251-4441
Practice Address - Country:US
Practice Address - Phone:603-745-2214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
NH2142225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist