Provider Demographics
NPI:1508143223
Name:DOW, ALYCE ELENA (OT)
Entity Type:Individual
Prefix:
First Name:ALYCE
Middle Name:ELENA
Last Name:DOW
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 1:88 NORWICH NEW LONDON TURNPIKE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382
Mailing Address - Country:US
Mailing Address - Phone:860-848-9157
Mailing Address - Fax:860-848-3477
Practice Address - Street 1:88 NORWICH NEW LONDON TPKE
Practice Address - Street 2:SUITE 1
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-2518
Practice Address - Country:US
Practice Address - Phone:860-848-9157
Practice Address - Fax:860-848-3477
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003810225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003810OtherSTATE OF CONNECTICUT LICENSE