Provider Demographics
NPI:1396529848
Name:ALLEN, ELIZABETH MAE (OTD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MAE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:MAE
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1502 JAY ST
Mailing Address - Street 2:
Mailing Address - City:WALNUT RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72476-1732
Mailing Address - Country:US
Mailing Address - Phone:870-408-0389
Mailing Address - Fax:
Practice Address - Street 1:221 LINDLEY LN
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-4954
Practice Address - Country:US
Practice Address - Phone:870-532-2124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty