Provider Demographics
NPI:1073387908
Name:CLOSSON, ALLISON DANIELLE (COTA/L)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:DANIELLE
Last Name:CLOSSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 HIGHWAY 91 W
Mailing Address - Street 2:
Mailing Address - City:BONO
Mailing Address - State:AR
Mailing Address - Zip Code:72416-8127
Mailing Address - Country:US
Mailing Address - Phone:870-919-7536
Mailing Address - Fax:
Practice Address - Street 1:5916 NEWCASTLE DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72405-8143
Practice Address - Country:US
Practice Address - Phone:870-919-7536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1983224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant