Provider Demographics
NPI:1659809218
Name:DUNHAM, ALLISON MARY (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:MARY
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:MARY
Other - Last Name:FEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 PARK VISTA DR UNIT 1131
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-3027
Mailing Address - Country:US
Mailing Address - Phone:815-520-0398
Mailing Address - Fax:
Practice Address - Street 1:6351 N FORT APACHE RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-2300
Practice Address - Country:US
Practice Address - Phone:702-515-2401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2019-06-12
Deactivation Date:2019-03-25
Deactivation Code:
Reactivation Date:2019-04-30
Provider Licenses
StateLicense IDTaxonomies
NV16-0759225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist