Provider Demographics
NPI:1174166896
Name:JENKINS, ALYSSA RAEANN (OTR/L)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:RAEANN
Last Name:JENKINS
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:G3030 N CENTER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-2665
Mailing Address - Country:US
Mailing Address - Phone:810-423-8822
Mailing Address - Fax:
Practice Address - Street 1:9444 LAPEER RD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1755
Practice Address - Country:US
Practice Address - Phone:810-652-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201013716225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist