Individual
MISS EBONY RAE ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1133 S JEFFERSON ST APT 9, ALLENTOWN, PA 18103-3888
(614) 596-6364
Mailing address
1133 S JEFFERSON ST APT 9, ALLENTOWN, PA 18103-3888
(614) 596-6364
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
212614
TX
224Z00000X
Occupational Therapy Assistant
Primary
OP009723
PA
224Z00000X
Occupational Therapy Assistant
OTA005619
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780178145
—
TX
Enumeration date
06/19/2018
Last updated
03/26/2020
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