Provider Demographics
NPI:1295604056
Name:ANDERSON, ALLYSON (OTR/L)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:ANDERSON
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 1:32 JOE KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-3417
Mailing Address - Country:US
Mailing Address - Phone:912-344-9657
Mailing Address - Fax:
Practice Address - Street 1:32 JOE KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-3417
Practice Address - Country:US
Practice Address - Phone:912-344-9657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-31
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist