Provider Demographics
NPI:1639529274
Name:SUNDERRAJ, ALIA FREDERICK (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALIA
Middle Name:FREDERICK
Last Name:SUNDERRAJ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ALIA
Other - Middle Name:FREDERICK
Other - Last Name:KUMPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:25 BRYDON WAY
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3678
Mailing Address - Country:US
Mailing Address - Phone:661-205-7852
Mailing Address - Fax:
Practice Address - Street 1:25 BRYDON WAY
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3678
Practice Address - Country:US
Practice Address - Phone:661-205-7852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3693225X00000X
MEOT4116225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist