Provider Demographics
NPI:1215110101
Name:LUTHI, ALYSSA E (OT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:E
Last Name:LUTHI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 HIGHWAY 53 E
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-3026
Mailing Address - Country:US
Mailing Address - Phone:706-624-3000
Mailing Address - Fax:
Practice Address - Street 1:14A PROFESSIONAL CT SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2832
Practice Address - Country:US
Practice Address - Phone:706-624-3000
Practice Address - Fax:706-624-3001
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004674225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA874307047AMedicaid
GA430957OtherWELLCARE
GA01158872OtherAMERIGROUP
GA52206285001OtherBLUE CROSS BLUE SHIELD