Provider Demographics
NPI:1275179418
Name:NELSON, ALICIA (BS, OT)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:BS, OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6060 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1907
Mailing Address - Country:US
Mailing Address - Phone:317-584-5166
Mailing Address - Fax:317-815-3861
Practice Address - Street 1:8064 E 900 N
Practice Address - Street 2:
Practice Address - City:WILKINSON
Practice Address - State:IN
Practice Address - Zip Code:46186-9693
Practice Address - Country:US
Practice Address - Phone:317-989-5823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003021A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist