Provider Demographics
NPI:1831343540
Name:ALLEN, THERESE R (MS/ OTR/L)
Entity type:Individual
Prefix:MISS
First Name:THERESE
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS/ OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 RENFREW RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-6905
Mailing Address - Country:US
Mailing Address - Phone:845-623-1556
Mailing Address - Fax:
Practice Address - Street 1:749 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-1902
Practice Address - Country:US
Practice Address - Phone:845-352-7140
Practice Address - Fax:845-352-7150
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014738-1225XP0200X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist