Provider Demographics
NPI:1558604462
Name:CORMIER, ALYSSA C (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:C
Last Name:CORMIER
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 1:607 EDELWEISS DR
Mailing Address - Street 2:GREEN BAY
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-5117
Mailing Address - Country:US
Mailing Address - Phone:920-609-3846
Mailing Address - Fax:
Practice Address - Street 1:607 EDELWEISS DR
Practice Address - Street 2:GREEN BAY
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-5117
Practice Address - Country:US
Practice Address - Phone:920-609-3846
Practice Address - Fax:715-524-5708
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5294-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist