Healthcare Provider Details

I. General information

NPI: 1760397210
Provider Name (Legal Business Name): ALISSA GUOAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 EAGLESON RD
GLADWIN MI
48624-8904
US

IV. Provider business mailing address

3636 EAGLESON RD
GLADWIN MI
48624-8904
US

V. Phone/Fax

Practice location:
  • Phone: 989-329-0390
  • Fax:
Mailing address:
  • Phone: 989-329-0390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201006362
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: