Provider Demographics
NPI:1114303328
Name:ALLEN, ANECIA DISHEL (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:ANECIA
Middle Name:DISHEL
Last Name:ALLEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:ANECIA
Other - Middle Name:DISHEL
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:101 PARK CT
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-1275
Mailing Address - Country:US
Mailing Address - Phone:864-362-5574
Mailing Address - Fax:864-761-1213
Practice Address - Street 1:101 PARK CT
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-1275
Practice Address - Country:US
Practice Address - Phone:864-362-5574
Practice Address - Fax:864-761-1213
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8313225700000X
NC9873225X00000X
SC5145225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC344257Medicaid