Provider Demographics
NPI:1568817179
Name:GRIFFIN, ALICIA (COTA)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4807 FERNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1723
Mailing Address - Country:US
Mailing Address - Phone:903-278-8700
Mailing Address - Fax:
Practice Address - Street 1:4807 FERNWOOD DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1723
Practice Address - Country:US
Practice Address - Phone:903-278-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1087224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant