MEDICARE: JADYN VICTORIA ALLEN MOT, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	2547	WV

General Provider Information

NPI Number	:	1184580037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADYN VICTORIA ALLEN MOT, OTR/L

Provider Business Mailing Address
First Line	:	PO BOX 264
Second Line	:
City	:	MOUNT CARBON
State	:	WV
Zip	:	25139-0264
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 RAIDER WAY
Second Line	:
City	:	SPENCER
State	:	WV
Zip	:	25276-9236
Country	:	US
Telephone Number	:	304-927-6400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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