Provider Demographics
NPI:1528227634
Name:MICKLEY, ALICIA ANN (MOTR/L)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:ANN
Last Name:MICKLEY
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3467 BLUE HEATHER DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-6362
Mailing Address - Country:US
Mailing Address - Phone:702-809-4476
Mailing Address - Fax:
Practice Address - Street 1:3467 BLUE HEATHER DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-6362
Practice Address - Country:US
Practice Address - Phone:702-809-4476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0568225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist