Provider Demographics
NPI:1194914481
Name:FORD, ALYSSA A (OTR)
Entity type:Individual
Prefix:MISS
First Name:ALYSSA
Middle Name:A
Last Name:FORD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 GALLEY CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-8855
Mailing Address - Country:US
Mailing Address - Phone:317-985-0118
Mailing Address - Fax:
Practice Address - Street 1:11570 E 126TH ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9592
Practice Address - Country:US
Practice Address - Phone:317-985-0118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2022-03-26
Deactivation Date:2022-03-09
Deactivation Code:
Reactivation Date:2022-03-26
Provider Licenses
StateLicense IDTaxonomies
IN31004309A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist