Healthcare Provider Details

I. General information

NPI: 1689250540
Provider Name (Legal Business Name): ALLYSON ELIZABETH WYKOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MENDEL PKWY W
MONTGOMERY AL
36117-5406
US

IV. Provider business mailing address

340 MENDEL PKWY W
MONTGOMERY AL
36117-5406
US

V. Phone/Fax

Practice location:
  • Phone: 334-532-0220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5461
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: