MEDICARE: MS. ALISHA WYNNE PHILIPPE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist		KY

General Provider Information

NPI Number	:	1184744146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALISHA WYNNE PHILIPPE

Provider Business Mailing Address
First Line	:	49 STERLING AVE
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-1148
Country	:	US
Telephone Number	:	859-442-9899
Fax Number	:

Provider Business Practice Location Address
First Line	:	49 STERLING AVE
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-1148
Country	:	US
Telephone Number	:	859-442-9899
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	03/04/2014

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