Provider Demographics
NPI:1154147650
Name:BACKERT, ALLISON NICOLE (OTR/L)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:NICOLE
Last Name:BACKERT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 HITCHING POST DR
Mailing Address - Street 2:
Mailing Address - City:RISING SUN
Mailing Address - State:MD
Mailing Address - Zip Code:21911-1698
Mailing Address - Country:US
Mailing Address - Phone:443-907-3200
Mailing Address - Fax:
Practice Address - Street 1:1881 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:MD
Practice Address - Zip Code:21911-2018
Practice Address - Country:US
Practice Address - Phone:410-658-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10231225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist