Provider Demographics
NPI:1326681008
Name:PHILLIPS, ALLISON Q (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:Q
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 STONER AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7318
Mailing Address - Country:US
Mailing Address - Phone:818-983-6960
Mailing Address - Fax:
Practice Address - Street 1:1818 STONER AVE APT 107
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7318
Practice Address - Country:US
Practice Address - Phone:818-983-6960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19073225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist