Provider Demographics
NPI:1497368716
Name:QUACH, ALICIA (OT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:QUACH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 POND PARK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4354
Mailing Address - Country:US
Mailing Address - Phone:813-375-5557
Mailing Address - Fax:781-741-6230
Practice Address - Street 1:2 POND PARK RD STE 102
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4354
Practice Address - Country:US
Practice Address - Phone:813-375-5557
Practice Address - Fax:781-741-6230
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13383225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist