Provider Demographics
NPI:1992096671
Name:OMALLEY, ALISON (COTA)
Entity type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:
Last Name:OMALLEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11319 E LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-4407
Mailing Address - Country:US
Mailing Address - Phone:317-571-1940
Mailing Address - Fax:
Practice Address - Street 1:7424 SHADELAND STATION WAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3925
Practice Address - Country:US
Practice Address - Phone:317-371-9232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001981A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant