Provider Demographics
NPI:1700912326
Name:ALLEN, JEROLYN GRACE (OTR)
Entity type:Individual
Prefix:MS
First Name:JEROLYN
Middle Name:GRACE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9151 W LISBON LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-2724
Mailing Address - Country:US
Mailing Address - Phone:623-933-0933
Mailing Address - Fax:
Practice Address - Street 1:9151 W LISBON LN
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-2724
Practice Address - Country:US
Practice Address - Phone:623-933-0933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ551225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics