Provider Demographics
NPI:1669918041
Name:SCHUSTER, ALISSA LORRAINE (COTA)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:LORRAINE
Last Name:SCHUSTER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:LORRAINE
Other - Last Name:DOPKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1737 NESQUALLY AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7358
Mailing Address - Country:US
Mailing Address - Phone:715-829-3718
Mailing Address - Fax:
Practice Address - Street 1:714 W PINE ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156-9046
Practice Address - Country:US
Practice Address - Phone:509-447-9308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC60687446224Z00000X
IDOTA1450224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant