Provider Demographics
NPI:1154772077
Name:COUCH, ALYSSA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:
Last Name:COUCH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:WALAWENDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:133 PANTHER DR
Mailing Address - Street 2:APT. 278
Mailing Address - City:CUMBERLAND GAP
Mailing Address - State:TN
Mailing Address - Zip Code:37724-4475
Mailing Address - Country:US
Mailing Address - Phone:828-226-5406
Mailing Address - Fax:
Practice Address - Street 1:215 RICHARDSON WAY
Practice Address - Street 2:
Practice Address - City:MAYNARDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37807-3803
Practice Address - Country:US
Practice Address - Phone:865-992-5816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5441225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist