Healthcare Provider Details

I. General information

NPI: 1043662935
Provider Name (Legal Business Name): ALYSSA HARVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9909 E 100 S
GREENTOWN IN
46936-9163
US

IV. Provider business mailing address

9418 E 300 S
GREENTOWN IN
46936-8980
US

V. Phone/Fax

Practice location:
  • Phone: 765-432-6611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number32002984A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: