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NPI Code Detail

MEDICARE: ALLISON RYAN OTR

MEDICARE: ALLISON RYAN OTR
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
1225X00000XOccupational Therapist5201009779MI

General Provider Information

NPI Number : 1396277224
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLISON RYAN OTR
Provider Business Mailing Address
First Line : 3495 S CENTER RD
Second Line :
City : BURTON
State : MI
Zip : 48519-1455
Country : US
Telephone Number : 810-424-2011
Fax Number :
Provider Business Practice Location Address
First Line : 8447 HOLLY RD
Second Line :
City : GRAND BLANC
State : MI
Zip : 48439-1888
Country : US
Telephone Number : 888-218-4045
Fax Number : 810-249-4230
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2017
Last Update Date : 09/03/2019

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