Provider Demographics
NPI:1275737215
Name:HANLEY, ALICE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:
Last Name:HANLEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:ALICE
Other - Middle Name:
Other - Last Name:GODEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:236 MARINER BLVD
Mailing Address - Street 2:KIDS FIRST THERAPY CENTER
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5691
Mailing Address - Country:US
Mailing Address - Phone:352-683-2120
Mailing Address - Fax:352-683-9232
Practice Address - Street 1:236 MARINER BLVD
Practice Address - Street 2:KIDS FIRST THERAPY CENTER
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5691
Practice Address - Country:US
Practice Address - Phone:352-683-2120
Practice Address - Fax:352-683-9232
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11309225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL355178OtherWELLCARE
FL2053VOtherBCBS
FL889247400Medicaid