Provider Demographics
NPI:1538449756
Name:MILLNER, ALYSON (OT)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:MILLNER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 E 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-7501
Mailing Address - Country:US
Mailing Address - Phone:907-301-9201
Mailing Address - Fax:907-868-8657
Practice Address - Street 1:235 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-7501
Practice Address - Country:US
Practice Address - Phone:907-301-9201
Practice Address - Fax:907-868-8657
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
AK2354225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1575653Medicaid