MEDICARE: KATELYN ALLEN OTD

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

General Provider Information

NPI Number	:	1376995209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN ALLEN OTD

Provider Business Mailing Address
First Line	:	1202 NE MCCLAIN RD STE 137
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72712-3875
Country	:	US
Telephone Number	:	479-407-4523
Fax Number	:	855-731-1394

Provider Business Practice Location Address
First Line	:	1202 NE MCCLAIN RD STE 137
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72712-3875
Country	:	US
Telephone Number	:	479-407-4523
Fax Number	:	855-731-1394

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

Provider Enumeration Date	:	07/03/2016
Last Update Date	:	04/19/2022

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