Provider Demographics
NPI:1386841823
Name:GENDRON, ALLISON MARIE (OTRL)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:GENDRON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:691 NW COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-4422
Mailing Address - Country:US
Mailing Address - Phone:413-454-4930
Mailing Address - Fax:
Practice Address - Street 1:300 S 18TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4661
Practice Address - Country:US
Practice Address - Phone:413-454-4930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA09127225X00000X
WA60031662225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist