Provider Demographics
NPI:1992045710
Name:MILLIGAN BOLLOW, ALLYSON LYNN
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:LYNN
Last Name:MILLIGAN BOLLOW
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 1:119 IRON CREEK COMMONS
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-9309
Mailing Address - Country:US
Mailing Address - Phone:910-471-2559
Mailing Address - Fax:
Practice Address - Street 1:10820 PENNY RD STE 113
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-1904
Practice Address - Country:US
Practice Address - Phone:919-303-7068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7272224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant