Provider Demographics
NPI:1497495832
Name:OTOOLE, ALICIA
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:OTOOLE
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 1:121 ANTONIA CT
Mailing Address - Street 2:
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-1537
Mailing Address - Country:US
Mailing Address - Phone:908-461-2831
Mailing Address - Fax:
Practice Address - Street 1:950 ROUTE 36
Practice Address - Street 2:
Practice Address - City:LEONARDO
Practice Address - State:NJ
Practice Address - Zip Code:07737-1709
Practice Address - Country:US
Practice Address - Phone:908-461-2831
Practice Address - Fax:732-355-6759
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01034500235Z00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ46TR01034500OtherSTATE OF NJ