Provider Demographics
NPI:1871990648
Name:SANDERS, ALYSSA ANN (COTA/L)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ANN
Last Name:SANDERS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 SHIPP LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:KY
Mailing Address - Zip Code:42740-9721
Mailing Address - Country:US
Mailing Address - Phone:270-735-2912
Mailing Address - Fax:
Practice Address - Street 1:106 DIECKS DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2443
Practice Address - Country:US
Practice Address - Phone:270-737-2738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA5414224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant