Provider Demographics
NPI:1629597752
Name:PURDUE, ALLISON
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:PURDUE
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 1:276 BEECH HILL RD
Mailing Address - Street 2:
Mailing Address - City:WENTWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03282-3221
Mailing Address - Country:US
Mailing Address - Phone:860-885-9158
Mailing Address - Fax:
Practice Address - Street 1:276 BEECH HILL RD
Practice Address - Street 2:
Practice Address - City:WENTWORTH
Practice Address - State:NH
Practice Address - Zip Code:03282-3221
Practice Address - Country:US
Practice Address - Phone:860-885-9158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-09
Last Update Date:2017-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty