Provider Demographics
NPI:1356645238
Name:VASILADIS, ALICIA
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:VASILADIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4280 MT. CARMEL
Mailing Address - Street 2:
Mailing Address - City:WIDSOR
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N9G2E1
Mailing Address - Country:CA
Mailing Address - Phone:412-310-6036
Mailing Address - Fax:
Practice Address - Street 1:4280 MT. CARMEL
Practice Address - Street 2:
Practice Address - City:WIDSOR
Practice Address - State:ONTARIO
Practice Address - Zip Code:N9G2E1
Practice Address - Country:CA
Practice Address - Phone:412-310-6036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist