MEDICARE: MS. ALLISON ELIZABETH GEDEON OTR, CLT

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	115725	TX

General Provider Information

NPI Number	:	1588173058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALLISON ELIZABETH GEDEON OTR, CLT

Provider Business Mailing Address
First Line	:	12606 GREENVILLE AVE STE 205
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-1927
Country	:	US
Telephone Number	:	214-613-2345
Fax Number	:

Provider Business Practice Location Address
First Line	:	12606 GREENVILLE AVE STE 205
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-1927
Country	:	US
Telephone Number	:	214-613-2345
Fax Number	:

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

Provider Enumeration Date	:	09/27/2017
Last Update Date	:	09/27/2017

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