Healthcare Provider Details

I. General information

NPI: 1912822685
Provider Name (Legal Business Name): ALYSSA DAUGHERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23933 ALLEN RD
WOODHAVEN MI
48183-3372
US

IV. Provider business mailing address

32353 BONDIE DR
ROCKWOOD MI
48173-1094
US

V. Phone/Fax

Practice location:
  • Phone: 734-307-0413
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201014714
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: