Provider Demographics
NPI:1831962679
Name:FLUCHEL, ALYSON JANELL
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:JANELL
Last Name:FLUCHEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 LAKE CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:BURFORDVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63739-8909
Mailing Address - Country:US
Mailing Address - Phone:573-238-7771
Mailing Address - Fax:
Practice Address - Street 1:18881 W DODGE RD STE 300W
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-4648
Practice Address - Country:US
Practice Address - Phone:877-230-3885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24896225X00000X
MTOTP-OT-LIC-10479225X00000X
MO2023011020225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist