Healthcare Provider Details

I. General information

NPI: 1588120638
Provider Name (Legal Business Name): ALLISON SIKSNUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 W INDIAN SCHOOL RD
PHOENIX AZ
85031-2605
US

IV. Provider business mailing address

860 N MCQUEEN RD UNIT 1136
CHANDLER AZ
85225-8101
US

V. Phone/Fax

Practice location:
  • Phone: 623-691-4000
  • Fax:
Mailing address:
  • Phone: 714-329-8586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-009323
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: