Provider Demographics
NPI:1780338830
Name:NORDMEYER, ALYSSA R
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:R
Last Name:NORDMEYER
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 1:152 ROSCOMMON DR UNIT 105
Mailing Address - Street 2:
Mailing Address - City:HARDEEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29927-2621
Mailing Address - Country:US
Mailing Address - Phone:815-546-5107
Mailing Address - Fax:
Practice Address - Street 1:4 OLIVER CT
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8708
Practice Address - Country:US
Practice Address - Phone:843-706-9367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5215224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant