Provider Demographics
NPI:1215560115
Name:ALT, TYLER MCLAINE (OTR)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:MCLAINE
Last Name:ALT
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 SONGBIRD LN UNIT F12
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54482-8514
Mailing Address - Country:US
Mailing Address - Phone:920-763-3939
Mailing Address - Fax:
Practice Address - Street 1:3380 BRIDLEWOOD DR
Practice Address - Street 2:
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467-3867
Practice Address - Country:US
Practice Address - Phone:715-342-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist