Healthcare Provider Details

I. General information

NPI: 1023947744
Provider Name (Legal Business Name): MADELINE ALLSUP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 W HUDSON RD
ROGERS AR
72756-2072
US

IV. Provider business mailing address

1200 COVINGTON WAY APT 3016
CONWAY AR
72034-0167
US

V. Phone/Fax

Practice location:
  • Phone: 479-936-1061
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: