Provider Demographics
NPI:1396044970
Name:CHRISTIANSON, ALLISON D'AVIGNON (OTR/L)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:D'AVIGNON
Last Name:CHRISTIANSON
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 1:61 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-5815
Mailing Address - Country:US
Mailing Address - Phone:860-540-0714
Mailing Address - Fax:
Practice Address - Street 1:61 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5815
Practice Address - Country:US
Practice Address - Phone:860-540-0714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3789225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist