Basic Information
| Provider Information | |||||||||
| NPI: | 1477288397 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATTHEWS | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | CAROL | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 W FLOWERS RD | ||||||||
| Address2: | |||||||||
| City: | TERRY | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391709795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014059691 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1225 N STATE ST | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392022064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019681000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2022 | ||||||||
| LastUpdateDate: | 07/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT3886 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.