Provider Demographics
NPI:1053851683
Name:CRAIGHEAD, ALICIA (OT)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:CRAIGHEAD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 HUDSON LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6035
Mailing Address - Country:US
Mailing Address - Phone:318-322-6500
Mailing Address - Fax:318-322-5118
Practice Address - Street 1:1103 HUDSON LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6035
Practice Address - Country:US
Practice Address - Phone:318-322-6500
Practice Address - Fax:318-322-5118
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ12505225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist