Provider Demographics
NPI:1750539797
Name:ALLISON, KASSIE A (OTR/L)
Entity type:Individual
Prefix:
First Name:KASSIE
Middle Name:A
Last Name:ALLISON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KASSIE
Other - Middle Name:A
Other - Last Name:PECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2033 W HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8304
Mailing Address - Country:US
Mailing Address - Phone:918-404-1535
Mailing Address - Fax:
Practice Address - Street 1:2033 W HOUSTON ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8304
Practice Address - Country:US
Practice Address - Phone:918-404-1535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1262225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics