Provider Demographics
NPI:1386154011
Name:BOYAN, ALLISON COOPER (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:COOPER
Last Name:BOYAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:JEANNE
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:180 MIDDLE HADDAM RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-1702
Mailing Address - Country:US
Mailing Address - Phone:860-301-7602
Mailing Address - Fax:
Practice Address - Street 1:1640 N. WELLS ST.
Practice Address - Street 2:UNIT 103
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:732-385-3566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist