Provider Demographics
NPI:1215403613
Name:STEWART, ALICE MARGARET (MA, ATR)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:MARGARET
Last Name:STEWART
Suffix:
Gender:F
Credentials:MA, ATR
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:MARGARET
Other - Last Name:MCDONOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 NORTHWOODS DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-7984
Mailing Address - Country:US
Mailing Address - Phone:814-308-3531
Mailing Address - Fax:
Practice Address - Street 1:3908 LONGSTREET ROAD BUILDING # 3-4303
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-908-7358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA17-460221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist