Provider Demographics
NPI:1225527872
Name:BRISENO POLEY, ALLISON BETH (OTR,MS/L)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:BETH
Last Name:BRISENO POLEY
Suffix:
Gender:F
Credentials:OTR,MS/L
Other - Prefix:MRS
Other - First Name:ALLISON
Other - Middle Name:BETH
Other - Last Name:POLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1829 DENVER WEST DR # 27
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3120
Mailing Address - Country:US
Mailing Address - Phone:303-982-2077
Mailing Address - Fax:
Practice Address - Street 1:1829 DENVER WEST DR # 27
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-3120
Practice Address - Country:US
Practice Address - Phone:303-982-2077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OT.0001753225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1060152OtherNBCOT