Healthcare Provider Details

I. General information

NPI: 1366756033
Provider Name (Legal Business Name): ALICIA MARIE BODDIE MS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA MARIE SANCHEZ MS OTR/L

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 ALLENS AVE
PROVIDENCE RI
02905-5443
US

IV. Provider business mailing address

529 EATON ST
PROVIDENCE RI
02908-2149
US

V. Phone/Fax

Practice location:
  • Phone: 401-432-6800
  • Fax:
Mailing address:
  • Phone: 617-777-3928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT01211
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: