Provider Demographics
NPI:1093375461
Name:CARROLL, ALICIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:CARROLL
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 1:6301 S WEST SHORE BLVD APT 1718
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33616-1369
Mailing Address - Country:US
Mailing Address - Phone:978-806-6572
Mailing Address - Fax:
Practice Address - Street 1:3500 OAK MANOR LN
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-1211
Practice Address - Country:US
Practice Address - Phone:727-581-9427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19555225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist