Provider Demographics
NPI:1376924381
Name:MARSHALL, ALICIA MARIE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:MARIE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:ALICIA
Other - Middle Name:MARIE
Other - Last Name:KIBBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:472B NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-4614
Mailing Address - Country:US
Mailing Address - Phone:774-287-8794
Mailing Address - Fax:
Practice Address - Street 1:472B NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-4614
Practice Address - Country:US
Practice Address - Phone:774-287-8794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC013915225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist