Provider Demographics
NPI:1508445214
Name:ORR, ALICIA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:ORR
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 KELLEY CT
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-1961
Mailing Address - Country:US
Mailing Address - Phone:617-314-3776
Mailing Address - Fax:
Practice Address - Street 1:9 KELLEY CT
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-1961
Practice Address - Country:US
Practice Address - Phone:617-922-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2131133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered