Provider Demographics
NPI:1295496503
Name:BLAIR, ALYSSA MARIE (OTR)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARIE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 W 1100S
Mailing Address - Street 2:
Mailing Address - City:HUNTINGBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47542-9634
Mailing Address - Country:US
Mailing Address - Phone:317-701-6604
Mailing Address - Fax:
Practice Address - Street 1:671 3RD AVE STE F
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3653
Practice Address - Country:US
Practice Address - Phone:317-701-6604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-08
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31007499A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist