Provider Demographics
NPI:1801909569
Name:DUTTON, ALYSON T (OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:T
Last Name:DUTTON
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-0457
Mailing Address - Country:US
Mailing Address - Phone:360-275-6612
Mailing Address - Fax:360-275-6658
Practice Address - Street 1:21 NE ROMANCE HILL RD STE 101
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-0457
Practice Address - Country:US
Practice Address - Phone:360-275-6612
Practice Address - Fax:360-275-6658
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002504224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8939144OtherL&I CRIME VICTIMS
WA8402851Medicaid
WA189859OtherL&I
WA3152DUOtherREGENCE
WA8850923Medicare ID - Type Unspecified
WA3152DUOtherREGENCE