Healthcare Provider Details

I. General information

NPI: 1942873393
Provider Name (Legal Business Name): ALLISON ALVENA SHUNK MS, OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E MICHIGAN AVE
JACKSON MI
49201-1498
US

IV. Provider business mailing address

2548 FESSENDEN ST APT 104
JACKSON MI
49201-3140
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-7252
  • Fax:
Mailing address:
  • Phone: 989-808-3891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201011253
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: