Provider Demographics
NPI:1568808277
Name:SISSON, ALICE ANN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:ANN
Last Name:SISSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 RIVERVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:COLONIAL BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:22443-4817
Mailing Address - Country:US
Mailing Address - Phone:540-840-1238
Mailing Address - Fax:
Practice Address - Street 1:112 RIVERVIEW CIR
Practice Address - Street 2:
Practice Address - City:COLONIAL BEACH
Practice Address - State:VA
Practice Address - Zip Code:22443-4817
Practice Address - Country:US
Practice Address - Phone:540-840-1238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002420224Z00000X
VA0019007687225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist