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General NPI Number Information
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NPI Number | 1376645812
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Entity Type | Individual
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Provider Name | ALICIA ANN WOMACK OTR L
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Gender | Female
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Dates
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Enumeration Date | 09/04/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1373 HIGHWAY 10 W
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City | PERRY
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State | AR
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Zip | 72125-8005
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Country | US
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Telephone | 501-662-4145
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Fax |
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Provider Business Mailing Address
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Address Line | 1373 HIGHWAY 10 W
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City | PERRY
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State | AR
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Zip | 72125-8005
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Country | US
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Telephone | 501-662-4145
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OTR1148
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License Number State | AR
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