Healthcare Provider Details

I. General information

NPI: 1780857128
Provider Name (Legal Business Name): ALICIA ANNE WATSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2923 CIRCLEWOOD DR
LITTLE ROCK AR
72207-2609
US

IV. Provider business mailing address

2923 CIRCLEWOOD DR
LITTLE ROCK AR
72207-2609
US

V. Phone/Fax

Practice location:
  • Phone: 501-661-9262
  • Fax:
Mailing address:
  • Phone: 501-661-9262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number765
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number765
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: