Provider Demographics
NPI:1578384483
Name:CHURCHILL, ALLISON NICOLE (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:NICOLE
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 BARLOW AVE
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1460
Mailing Address - Country:US
Mailing Address - Phone:856-430-6828
Mailing Address - Fax:
Practice Address - Street 1:29 EMMONS DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-5919
Practice Address - Country:US
Practice Address - Phone:609-454-3035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01207400225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics