Provider Demographics
NPI:1144508813
Name:ROLAND, ALICIA K (OTR/L)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:K
Last Name:ROLAND
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2993 N CREEK RD
Mailing Address - Street 2:APT. 2
Mailing Address - City:PALMYRA
Mailing Address - State:NY
Mailing Address - Zip Code:14522-9226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2993 N CREEK RD
Practice Address - Street 2:APT. 2
Practice Address - City:PALMYRA
Practice Address - State:NY
Practice Address - Zip Code:14522-9226
Practice Address - Country:US
Practice Address - Phone:315-573-4856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016843225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY016843OtherNEW YORK STATE LICENSE