Healthcare Provider Details

I. General information

NPI: 1174175715
Provider Name (Legal Business Name): ALYSSA OBERHOLZER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA HAMMOND

II. Dates (important events)

Enumeration Date: 07/14/2019
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 N 155TH ST STE B
BASEHOR KS
66007-7100
US

IV. Provider business mailing address

1106 N 155TH ST STE B
BASEHOR KS
66007-7100
US

V. Phone/Fax

Practice location:
  • Phone: 913-662-7071
  • Fax:
Mailing address:
  • Phone: 913-662-7071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-3861
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: