Healthcare Provider Details

I. General information

NPI: 1174494702
Provider Name (Legal Business Name): ALYSSA DAHLHEIMER OTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 09/16/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 SMITH AVE N STE 120
SAINT PAUL MN
55102-2579
US

IV. Provider business mailing address

778 YORKTOWN PL
EAGAN MN
55123-2084
US

V. Phone/Fax

Practice location:
  • Phone: 651-241-7560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number102774
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: