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NPI Code Detail

MEDICARE: ALISSA RALYNN HAYES MS, OTD, OTR

MEDICARE: ALISSA RALYNN HAYES MS, OTD, OTR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOT010596OH
2225XP0200XPediatric Occupational Therapist31004874AIN
3225X00000XOccupational Therapist31004874AIN

General Provider Information

NPI Number : 1629549456
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALISSA RALYNN HAYES MS, OTD, OTR
Provider Business Mailing Address
First Line : 3500 DEPAUW BLVD STE 3070
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-6135
Country : US
Telephone Number : 855-324-0885
Fax Number : 317-520-8200
Provider Business Practice Location Address
First Line : 3500 DEPAUW BLVD STE 3070
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-6135
Country : US
Telephone Number : 855-324-0885
Fax Number : 317-520-8200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2018
Last Update Date : 07/23/2019

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