Provider Demographics
NPI:1699010546
Name:FILLMORE, ALISON (MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ALISON
Middle Name:
Last Name:FILLMORE
Suffix:
Gender:F
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 1:215 N J ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-1927
Mailing Address - Country:US
Mailing Address - Phone:253-576-2817
Mailing Address - Fax:
Practice Address - Street 1:2689 HOOVER AVE SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3013
Practice Address - Country:US
Practice Address - Phone:360-443-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60248754225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics