Provider Demographics
NPI:1356456842
Name:DOLL, ALICE FREDA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:FREDA
Last Name:DOLL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24932 E CEDAR LAKE DR
Mailing Address - Street 2:
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-7810
Mailing Address - Country:US
Mailing Address - Phone:952-758-4427
Mailing Address - Fax:952-758-4427
Practice Address - Street 1:24932 E CEDAR LAKE DR
Practice Address - Street 2:
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-7810
Practice Address - Country:US
Practice Address - Phone:952-758-4427
Practice Address - Fax:952-758-4427
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100015225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN53177DOOtherBC/BS