Provider Demographics
NPI:1376645812
Name:WOMACK, ALICIA ANN (OTR L)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANN
Last Name:WOMACK
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1373 HIGHWAY 10 W
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:AR
Mailing Address - Zip Code:72125-8005
Mailing Address - Country:US
Mailing Address - Phone:501-662-4145
Mailing Address - Fax:
Practice Address - Street 1:1373 HIGHWAY 10 W
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:AR
Practice Address - Zip Code:72125-8005
Practice Address - Country:US
Practice Address - Phone:501-662-4145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1148225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T631OtherBLUE CROSS BLUE SHEILD #