Provider Demographics
NPI:1255722930
Name:ALLEN, MARYANN (OT)
Entity type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:MARYANN
Other - Middle Name:
Other - Last Name:MARANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:301 HESTERS CROSSING RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-6946
Mailing Address - Country:US
Mailing Address - Phone:512-310-1928
Mailing Address - Fax:512-310-9180
Practice Address - Street 1:301 HESTERS CROSSING RD
Practice Address - Street 2:SUITE 160
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-6946
Practice Address - Country:US
Practice Address - Phone:512-310-1928
Practice Address - Fax:512-310-9180
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111965225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111965OtherSTATE LICENSE