Healthcare Provider Details

I. General information

NPI: 1437407384
Provider Name (Legal Business Name): ALISHA GRACE SEMPREBON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 NORTH MAIN STREET
LACONIA NH
03246
US

IV. Provider business mailing address

806 NORTH MAIN STREET
LACONIA NH
03246
US

V. Phone/Fax

Practice location:
  • Phone: 603-524-9090
  • Fax: 603-524-1497
Mailing address:
  • Phone: 603-524-9090
  • Fax: 603-524-1497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2157
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: