Provider Demographics
NPI:1114252723
Name:MAUTZ, ALLISON J (BA; COTA/L)
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:J
Last Name:MAUTZ
Suffix:
Gender:F
Credentials:BA; COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 EL JEMA FOREST DR.
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673
Mailing Address - Country:US
Mailing Address - Phone:864-422-1195
Mailing Address - Fax:
Practice Address - Street 1:311 SIMPSON RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2157
Practice Address - Country:US
Practice Address - Phone:864-231-7397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2827174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist