Provider Demographics
NPI:1801624960
Name:MILAM, ALLISON
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:MILAM
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:PO BOX 701
Mailing Address - Street 2:
Mailing Address - City:GLEN DANIEL
Mailing Address - State:WV
Mailing Address - Zip Code:25844-0701
Mailing Address - Country:US
Mailing Address - Phone:304-890-6268
Mailing Address - Fax:
Practice Address - Street 1:140 DEERHAVEN DR
Practice Address - Street 2:
Practice Address - City:GLEN DANIEL
Practice Address - State:WV
Practice Address - Zip Code:25844
Practice Address - Country:US
Practice Address - Phone:304-890-6268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty