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NPI Code Detail

MEDICARE: MR. ALICE D PETRANEK OTR/L

MEDICARE: MR. ALICE D PETRANEK OTR/L
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
1225X00000XOccupational Therapist112473NY

General Provider Information

NPI Number : 1699054692
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ALICE D PETRANEK OTR/L
Provider Business Mailing Address
First Line : 2990 LEGACY DR
Second Line :
City : FRISCO
State : TX
Zip : 75034-6066
Country : US
Telephone Number : 469-888-5172
Fax Number :
Provider Business Practice Location Address
First Line : 4101 W ARKANSAS LN
Second Line :
City : ARLINGTON
State : TX
Zip : 76016-1496
Country : US
Telephone Number : 877-407-3422
Fax Number : 877-407-4329
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2011
Last Update Date : 04/01/2025

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