Provider Demographics
NPI:1033480728
Name:ALLEN, SANDRA JANE (OT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JANE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:SANDIA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:87047-9306
Mailing Address - Country:US
Mailing Address - Phone:505-681-2911
Mailing Address - Fax:
Practice Address - Street 1:10 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:SANDIA PARK
Practice Address - State:NM
Practice Address - Zip Code:87047-9306
Practice Address - Country:US
Practice Address - Phone:505-681-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1766225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist