Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 31000726A | IN |
N | 225XH1200X | Occupational Therapist - Hand | 31000726A | IN |
NPI | 1063815389 |
---|---|
Provider Name | Ms. Laurie Susan Allen |
First Address | Bloomington, IN 47401-8368 |
Second Address | Bloomington, IN 47401-5515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2014 |
Last Update Date | 12/06/2019 |