Healthcare Provider Details

I. General information

NPI: 1194243451
Provider Name (Legal Business Name): ALYSSA DEUTSCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 09/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 S LEMAY AVE
FORT COLLINS CO
80525-1900
US

IV. Provider business mailing address

2201 S LEMAY AVE
FORT COLLINS CO
80525-1900
US

V. Phone/Fax

Practice location:
  • Phone: 970-221-1167
  • Fax:
Mailing address:
  • Phone: 970-221-1167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0004251
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: