Provider Demographics
NPI:1730807967
Name:ALICEA, ITALIA NICOLE (OTR/L)
Entity type:Individual
Prefix:
First Name:ITALIA
Middle Name:NICOLE
Last Name:ALICEA
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 1:14939 TWINBERRY DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7332
Mailing Address - Country:US
Mailing Address - Phone:808-220-1707
Mailing Address - Fax:
Practice Address - Street 1:113 W CHAPMAN RD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8895
Practice Address - Country:US
Practice Address - Phone:407-790-5601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23410261Q00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center