Provider Demographics
NPI:1285393256
Name:SLAKER, ALYSSA ROSE (OTRL)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ROSE
Last Name:SLAKER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9271 WESTBURY AVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4729
Mailing Address - Country:US
Mailing Address - Phone:734-679-1550
Mailing Address - Fax:
Practice Address - Street 1:850 S HEWITT RD STE W
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-4594
Practice Address - Country:US
Practice Address - Phone:734-554-5561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201012706225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist