MEDICARE: KRISTI LYNN ALLISON

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	OT 11543	CA
2	225XP0200X	Pediatric Occupational Therapist	OT 11543	CA

General Provider Information

NPI Number	:	1710264502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI LYNN ALLISON

Provider Business Mailing Address
First Line	:	340 TESCONI CIR
Second Line	:	SUITE C
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-4676
Country	:	US
Telephone Number	:	707-546-9160
Fax Number	:	707-546-1338

Provider Business Practice Location Address
First Line	:	340 TESCONI CIR
Second Line	:	SUITE C
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-4676
Country	:	US
Telephone Number	:	707-546-9160
Fax Number	:	707-546-1338

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

Provider Enumeration Date	:	11/08/2011
Last Update Date	:	11/08/2011

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Directions to “ KRISTI LYNN ALLISON ” Practice Location

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