Provider Demographics
NPI:1881263861
Name:TREADWELL, ALLISON RANDOLPH (OTR/L)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:RANDOLPH
Last Name:TREADWELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:691 JOHNYCAKE RD
Mailing Address - Street 2:
Mailing Address - City:MOHAWK
Mailing Address - State:NY
Mailing Address - Zip Code:13407-4638
Mailing Address - Country:US
Mailing Address - Phone:315-867-4373
Mailing Address - Fax:
Practice Address - Street 1:691 JOHNYCAKE RD
Practice Address - Street 2:
Practice Address - City:MOHAWK
Practice Address - State:NY
Practice Address - Zip Code:13407-4638
Practice Address - Country:US
Practice Address - Phone:315-867-4373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011684-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist