Provider Demographics
NPI:1164248183
Name:CASEY, ALYSSA NICOLE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:NICOLE
Last Name:CASEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 DEESE ST
Mailing Address - Street 2:
Mailing Address - City:BEEBE
Mailing Address - State:AR
Mailing Address - Zip Code:72012-2050
Mailing Address - Country:US
Mailing Address - Phone:501-239-3353
Mailing Address - Fax:
Practice Address - Street 1:1001 DEESE ST
Practice Address - Street 2:
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012-2050
Practice Address - Country:US
Practice Address - Phone:501-239-3353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2449225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist