Provider Demographics
NPI:1538791348
Name:LAVERY, ALLISON M (OTR/L)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:M
Last Name:LAVERY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 CHASE WAY
Mailing Address - Street 2:MANCHESTER, NH
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104
Mailing Address - Country:US
Mailing Address - Phone:603-703-8831
Mailing Address - Fax:
Practice Address - Street 1:170 CHASE WAY
Practice Address - Street 2:MANCHESTER, NH
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-0310
Practice Address - Country:US
Practice Address - Phone:603-703-8831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024158225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty