Provider Demographics
NPI:1124901863
Name:RYESON, ALLYSSA JOE
Entity type:Individual
Prefix:
First Name:ALLYSSA
Middle Name:JOE
Last Name:RYESON
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 1:9379 OAK RD
Mailing Address - Street 2:
Mailing Address - City:OTISVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48463-9745
Mailing Address - Country:US
Mailing Address - Phone:810-895-1903
Mailing Address - Fax:
Practice Address - Street 1:585 E FLINT ST
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-3209
Practice Address - Country:US
Practice Address - Phone:248-693-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist