Provider Demographics
NPI:1568233013
Name:SEGERSON, ALLISEN (OTR)
Entity Type:Individual
Prefix:
First Name:ALLISEN
Middle Name:
Last Name:SEGERSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SOUTH STREET
Mailing Address - Street 2:STE. 500
Mailing Address - City:VIDOR
Mailing Address - State:TX
Mailing Address - Zip Code:77662
Mailing Address - Country:US
Mailing Address - Phone:254-640-0670
Mailing Address - Fax:
Practice Address - Street 1:500 SOUTH STREET
Practice Address - Street 2:STE. 500
Practice Address - City:VIDOR
Practice Address - State:TX
Practice Address - Zip Code:77662
Practice Address - Country:US
Practice Address - Phone:254-640-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124308225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist