Provider Demographics
NPI:1326682691
Name:ENGLE, ALYSSA CHURCHILL (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:CHURCHILL
Last Name:ENGLE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:CHURCHILL
Other - Last Name:JAMESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, OTR
Mailing Address - Street 1:412 W KINNE STREET SUITE 171
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:54011
Mailing Address - Country:US
Mailing Address - Phone:715-273-6759
Mailing Address - Fax:715-273-6854
Practice Address - Street 1:412 W KINNE STREET
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:WI
Practice Address - Zip Code:54011
Practice Address - Country:US
Practice Address - Phone:715-273-6759
Practice Address - Fax:715-273-6854
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14688225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist