Provider Demographics
NPI:1124141544
Name:ELLIOTT-RECTOR, ALISA TANYA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:TANYA
Last Name:ELLIOTT-RECTOR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-0321
Mailing Address - Country:US
Mailing Address - Phone:907-746-7300
Mailing Address - Fax:907-746-7302
Practice Address - Street 1:7335 E. PALMER WASILLA HWY.
Practice Address - Street 2:SUITE 1A
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645
Practice Address - Country:US
Practice Address - Phone:907-746-7300
Practice Address - Fax:907-746-7302
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1269225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOT3407Medicare ID - Type Unspecified