Provider Demographics
NPI:1740949890
Name:ALLEN, DOUGLAS JAMES (OT)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JAMES
Last Name:ALLEN
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13021 CENTRAL AVE UNIT 303
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5880
Mailing Address - Country:US
Mailing Address - Phone:310-363-5516
Mailing Address - Fax:
Practice Address - Street 1:13021 CENTRAL AVE UNIT 303
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5880
Practice Address - Country:US
Practice Address - Phone:310-363-5516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6221225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist