Provider Demographics
NPI:1558733220
Name:LOCKE, ALYSSA K (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:K
Last Name:LOCKE
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 1:101 S-37-349
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29672
Mailing Address - Country:US
Mailing Address - Phone:864-885-7675
Mailing Address - Fax:
Practice Address - Street 1:101 S-37-349
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672
Practice Address - Country:US
Practice Address - Phone:864-885-7675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10024225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4691OtherSC BOARD OF OCCUPATIONAL THERAPY
NC10024OtherNORTH CAROLINA BOARD OF OCCUPATIONAL THERAPY