Healthcare Provider Details

I. General information

NPI: 1568377935
Provider Name (Legal Business Name): ALLYSON SAN ROMAN OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 MCGAVOCK PIKE
NASHVILLE TN
37216-3225
US

IV. Provider business mailing address

559 WATSONWOOD DR
NASHVILLE TN
37211-5320
US

V. Phone/Fax

Practice location:
  • Phone: 615-652-2344
  • Fax:
Mailing address:
  • Phone: 714-305-1678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8852
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: