Healthcare Provider Details

I. General information

NPI: 1467603985
Provider Name (Legal Business Name): ALLISON T CARROLL MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 BALFOUR RD
WEST MEMPHIS AR
72301-1701
US

IV. Provider business mailing address

300 W COOPER AVE
WEST MEMPHIS AR
72301-3918
US

V. Phone/Fax

Practice location:
  • Phone: 870-733-9950
  • Fax:
Mailing address:
  • Phone: 901-240-9848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR1468
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: