Individual
ALYSSA DOUGLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ORT/L
Contact information
Practice address
2510 LAKE MICHIGAN DR NW, GRAND RAPIDS, MI 49504-8042
(616) 259-0408
Mailing address
1617 E MILHAM AVE STE B, PORTAGE, MI 49002-3049
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
225X00000X
Occupational Therapist
Primary
5201011419
MI
Other
Enumeration date
06/26/2018
Last updated
10/21/2021
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