Provider Demographics
NPI:1407511769
Name:LEVENGOOD, ALLISON GRACE (OT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:GRACE
Last Name:LEVENGOOD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:GRACE
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:702 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-5040
Mailing Address - Country:US
Mailing Address - Phone:870-464-1337
Mailing Address - Fax:
Practice Address - Street 1:702 HICKORY ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5040
Practice Address - Country:US
Practice Address - Phone:870-464-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3593225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist