Provider Demographics
NPI:1851924898
Name:MIXER, ALISON K (OTR/L)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:K
Last Name:MIXER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:K
Other - Last Name:BOCKMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2516 E COUNTY ROAD 0
Mailing Address - Street 2:
Mailing Address - City:LA PRAIRIE
Mailing Address - State:IL
Mailing Address - Zip Code:62346-2000
Mailing Address - Country:US
Mailing Address - Phone:308-391-0596
Mailing Address - Fax:
Practice Address - Street 1:1200 E GRANT ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-3499
Practice Address - Country:US
Practice Address - Phone:309-833-2123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056013231225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist