Provider Demographics
NPI:1790292944
Name:LAASCH, ALISSA M (OT)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:M
Last Name:LAASCH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:M
Other - Last Name:STRAUB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:800-326-2250
Mailing Address - Fax:
Practice Address - Street 1:N84W16889 MENOMONEE AVE
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2810
Practice Address - Country:US
Practice Address - Phone:262-250-1870
Practice Address - Fax:262-532-1588
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6028225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100074466Medicaid