Provider Demographics
NPI:1548845548
Name:ALLEN, CHRISTOPHER LANCE (OTA, LMT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LANCE
Last Name:ALLEN
Suffix:
Gender:M
Credentials:OTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3262 HAWKS NEST DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7521
Mailing Address - Country:US
Mailing Address - Phone:407-617-1108
Mailing Address - Fax:
Practice Address - Street 1:3262 HAWKS NEST DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7521
Practice Address - Country:US
Practice Address - Phone:407-617-1108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL34057225700000X
FL17702224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist