Healthcare Provider Details

I. General information

NPI: 1043797640
Provider Name (Legal Business Name): ALYSSA PLOUFFE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10770 ELIZABETH LAKE RD
WHITE LAKE MI
48386-2136
US

IV. Provider business mailing address

480 SUNSET BOUELVARD
OXFORD MI
48371
US

V. Phone/Fax

Practice location:
  • Phone: 248-618-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5202007475
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: