Provider Demographics
NPI:1295322964
Name:BOONE, ALLAUNA MARIE (COTA/L)
Entity type:Individual
Prefix:
First Name:ALLAUNA
Middle Name:MARIE
Last Name:BOONE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402B CAMELLIA DR
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4658
Mailing Address - Country:US
Mailing Address - Phone:479-477-1250
Mailing Address - Fax:
Practice Address - Street 1:910 NW 7TH ST STE 2&4
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4565
Practice Address - Country:US
Practice Address - Phone:479-250-9838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1453224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant