Provider Demographics
NPI:1538496591
Name:LAVERE, ALICIA (OT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:LAVERE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:MONTURANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:540 W MERCHANT ST
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:NJ
Mailing Address - Zip Code:08106-1910
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:619 N FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-1714
Practice Address - Country:US
Practice Address - Phone:956-533-8923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2019-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10921225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist