Provider Demographics
NPI:1649454653
Name:ELLISON, ALYSSA LYNN (OT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LYNN
Last Name:ELLISON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:LYNN
Other - Last Name:ROZICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:555 COUNTY ROAD HQ
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-8855
Mailing Address - Country:US
Mailing Address - Phone:906-225-5044
Mailing Address - Fax:906-225-5049
Practice Address - Street 1:2525 7TH AVE SOUTH
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1237
Practice Address - Country:US
Practice Address - Phone:906-786-0408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007320225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist