Provider Demographics
NPI:1679058481
Name:EDWARDS, ALLYSON (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36918 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33523-3203
Mailing Address - Country:US
Mailing Address - Phone:336-339-4974
Mailing Address - Fax:
Practice Address - Street 1:701 N WILDER RD
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566-7547
Practice Address - Country:US
Practice Address - Phone:813-752-3611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19520225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist