Provider Demographics
NPI:1003541160
Name:ALLEN, ALLISON ANNE (OT/L)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:ANNE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 STILLWATER DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7151
Mailing Address - Country:US
Mailing Address - Phone:928-776-9285
Mailing Address - Fax:928-776-7753
Practice Address - Street 1:3160 STILLWATER DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7151
Practice Address - Country:US
Practice Address - Phone:928-925-0553
Practice Address - Fax:928-776-7753
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH-002604225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist