Provider Demographics
NPI:1972313427
Name:KOWALCHUK, ALYSSA NOEL LEMERE
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:NOEL LEMERE
Last Name:KOWALCHUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:NOEL
Other - Last Name:LEMERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34720 N ASHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85144-0111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34720 N ASHWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85144-0111
Practice Address - Country:US
Practice Address - Phone:480-309-0113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH009511225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTH-009511OtherARIZONA BOARD OF OCCUPATIONAL THERAPY EXAMINERS