MEDICARE: ALICIA J OLDHAM OT

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	1321	NE
2	225XP0200X	Pediatric Occupational Therapist	10448	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598941643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA J OLDHAM OT

Provider Business Mailing Address
First Line	:	18350 MT. LANGLEY STREET
Second Line	:	105
City	:	IRVINE
State	:	CA
Zip	:	92708
Country	:	US
Telephone Number	:	714-965-2324
Fax Number	:

Provider Business Practice Location Address
First Line	:	18350 MOUNT LANGLEY ST
Second Line	:	105
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-6900
Country	:	US
Telephone Number	:	714-965-2324
Fax Number	:

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

Provider Enumeration Date	:	01/18/2008
Last Update Date	:	04/13/2009

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Directions to “ ALICIA J OLDHAM OT” Practice Location

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