Provider Demographics
NPI:1417694894
Name:DILLINGHAM, ALLYSON L
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:L
Last Name:DILLINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PINE FOREST DR APT 13
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6912
Mailing Address - Country:US
Mailing Address - Phone:774-274-8362
Mailing Address - Fax:
Practice Address - Street 1:301 PINE FOREST DR APT 13
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-6912
Practice Address - Country:US
Practice Address - Phone:774-274-8362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty