MEDICARE: MRS. ALICE HANLEY OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT11309	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	355178	OTHER	FL	WELLCARE
2	2053V	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275737215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALICE HANLEY OTR

Provider Business Mailing Address
First Line	:	236 MARINER BLVD
Second Line	:	KIDS FIRST THERAPY CENTER
City	:	SPRING HILL
State	:	FL
Zip	:	34609-5691
Country	:	US
Telephone Number	:	352-683-2120
Fax Number	:	352-683-9232

Provider Business Practice Location Address
First Line	:	236 MARINER BLVD
Second Line	:	KIDS FIRST THERAPY CENTER
City	:	SPRING HILL
State	:	FL
Zip	:	34609-5691
Country	:	US
Telephone Number	:	352-683-2120
Fax Number	:	352-683-9232

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	03/08/2016

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