Provider Demographics
NPI:1962423350
Name:HAAS, ALYCIA MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:ALYCIA
Middle Name:MARIE
Last Name:HAAS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ALYCIA
Other - Middle Name:MARIE
Other - Last Name:SHREFLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6827 HIGHWAY 25 S
Mailing Address - Street 2:
Mailing Address - City:NINETY SIX
Mailing Address - State:SC
Mailing Address - Zip Code:29666-9294
Mailing Address - Country:US
Mailing Address - Phone:864-223-5230
Mailing Address - Fax:
Practice Address - Street 1:310 CALHOUN AVE STE H
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-2028
Practice Address - Country:US
Practice Address - Phone:864-388-7529
Practice Address - Fax:864-388-7528
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2912225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1642Medicaid