Provider Demographics
NPI:1679076111
Name:ANTON, ALYSSA KRYSTINE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:KRYSTINE
Last Name:ANTON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12393 NICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:MI
Mailing Address - Zip Code:48457-9763
Mailing Address - Country:US
Mailing Address - Phone:810-280-9712
Mailing Address - Fax:
Practice Address - Street 1:1057 E COLDWATER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505-1501
Practice Address - Country:US
Practice Address - Phone:810-496-5172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009689225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist