Healthcare Provider Details

I. General information

NPI: 1346052263
Provider Name (Legal Business Name): ALYSSA CHESTNUT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 07/27/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 CENTENNIAL WAY STE 160
LANSING MI
48917-8238
US

IV. Provider business mailing address

836 CENTENNIAL WAY STE 160
LANSING MI
48917-8238
US

V. Phone/Fax

Practice location:
  • Phone: 517-798-3677
  • Fax: 517-539-6764
Mailing address:
  • Phone: 517-798-3677
  • Fax: 517-539-6764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056016392
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: