Provider Demographics
NPI:1871052365
Name:ALLEN, HAYDEN RILEY (COTA/L)
Entity type:Individual
Prefix:
First Name:HAYDEN
Middle Name:RILEY
Last Name:ALLEN
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 W BILLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:TX
Mailing Address - Zip Code:76706-5010
Mailing Address - Country:US
Mailing Address - Phone:254-424-8656
Mailing Address - Fax:
Practice Address - Street 1:7801 WOODWAY DR
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-3860
Practice Address - Country:US
Practice Address - Phone:254-235-7801
Practice Address - Fax:254-235-5834
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215613224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant