Provider Demographics
NPI:1629559471
Name:MARON, ALYSSA R
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:R
Last Name:MARON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20675 BALINSKI DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5611
Mailing Address - Country:US
Mailing Address - Phone:586-942-2910
Mailing Address - Fax:
Practice Address - Street 1:20675 BALINSKI DR
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-5611
Practice Address - Country:US
Practice Address - Phone:586-942-2910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0005489225X00000X
TX119263225X00000X
VA0119007820225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist