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General NPI Number Information
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NPI Number | 1215110101
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Entity Type | Individual
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Provider Name | ALYSSA E LUTHI OT
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Gender | Female
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Dates
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Enumeration Date | 12/13/2007
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Last Update Date | 06/17/2010
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Provider Practice Location Address
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Address Line | 14A PROFESSIONAL CT SW
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City | ROME
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State | GA
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Zip | 30165-2832
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Country | US
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Telephone | 706-624-3000
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Fax | 706-624-3001
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Provider Business Mailing Address
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Address Line | 263 HIGHWAY 53 E
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City | CALHOUN
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State | GA
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Zip | 30701-3026
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Country | US
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Telephone | 706-624-3000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT004674
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License Number State | GA
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