Provider Demographics
NPI:1508906488
Name:PUCCIO, ALICIA ESTHER (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:ESTHER
Last Name:PUCCIO
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 1:572 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1359
Mailing Address - Country:US
Mailing Address - Phone:631-758-0089
Mailing Address - Fax:
Practice Address - Street 1:572 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1359
Practice Address - Country:US
Practice Address - Phone:631-758-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007164225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHUP243425OtherSTATE DRIVER'S LICENSE