Provider Demographics
NPI:1427301621
Name:RICARD, ALISSA ERIN (OTD)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:ERIN
Last Name:RICARD
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9435 HARBOR COVE CIRCLE
Mailing Address - Street 2:APT 241
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189
Mailing Address - Country:US
Mailing Address - Phone:520-360-9580
Mailing Address - Fax:
Practice Address - Street 1:9345 HARBOR COVE CIRCLE
Practice Address - Street 2:APT 241
Practice Address - City:WHITMORE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48189
Practice Address - Country:US
Practice Address - Phone:520-360-9580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.008154225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist