Provider Demographics
NPI:1558633081
Name:ALLISON, CHARLES DAN JR (MS, OTR/L)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:DAN
Last Name:ALLISON
Suffix:JR
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2395 RIVIERA RD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-8447
Mailing Address - Country:US
Mailing Address - Phone:662-325-0886
Mailing Address - Fax:662-325-0896
Practice Address - Street 1:326 HARDY ROAD
Practice Address - Street 2:
Practice Address - City:MISSISSIPPPI STATE
Practice Address - State:MS
Practice Address - Zip Code:39762
Practice Address - Country:US
Practice Address - Phone:662-325-1028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2147225X00000X, 225XR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility