Provider Demographics
NPI:1235669722
Name:DISHMAN, ALLISON (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:DISHMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 CORNERSTONE ST APT 306
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5385
Mailing Address - Country:US
Mailing Address - Phone:919-539-2664
Mailing Address - Fax:
Practice Address - Street 1:30 MONICA BLVD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2269
Practice Address - Country:US
Practice Address - Phone:434-515-1247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006815225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist