Provider Demographics
NPI:1437395001
Name:ALICANDRO, MILENA (OTR/L)
Entity Type:Individual
Prefix:
First Name:MILENA
Middle Name:
Last Name:ALICANDRO
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 1:1999 MARCUS AVE
Mailing Address - Street 2:STE M15
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1507
Mailing Address - Country:US
Mailing Address - Phone:516-488-8808
Mailing Address - Fax:516-488-8818
Practice Address - Street 1:1999 MARCUS AVE STE M15
Practice Address - Street 2:
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042-1507
Practice Address - Country:US
Practice Address - Phone:516-488-8808
Practice Address - Fax:516-488-8818
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-01
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004958225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist