Healthcare Provider Details

I. General information

NPI: 1508564188
Provider Name (Legal Business Name): ALYSSA NICHOLS MSOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 DOUGLAS AVE
URBANDALE IA
50322-2450
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 515-251-3700
  • Fax: 515-251-3733
Mailing address:
  • Phone: 630-575-1980
  • Fax: 706-650-1896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT008722
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number107438
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: