Healthcare Provider Details

I. General information

NPI: 1699010546
Provider Name (Legal Business Name): ALISON NILES MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. ALISON FILLMORE

II. Dates (important events)

Enumeration Date: 12/04/2012
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3837 S 12TH ST
TACOMA WA
98405-2138
US

IV. Provider business mailing address

3837 S 12TH ST
TACOMA WA
98405-2138
US

V. Phone/Fax

Practice location:
  • Phone: 833-971-1230
  • Fax:
Mailing address:
  • Phone: 833-971-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT60248754
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: