Provider Demographics
NPI:1700845385
Name:ALICEA, BLANCA IRIS (OTRL)
Entity Type:Individual
Prefix:MS
First Name:BLANCA
Middle Name:IRIS
Last Name:ALICEA
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4RN26 VIA ISABEL
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-4839
Mailing Address - Country:US
Mailing Address - Phone:787-767-7676
Mailing Address - Fax:787-764-9904
Practice Address - Street 1:4RN26 VIA ISABEL
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-4839
Practice Address - Country:US
Practice Address - Phone:787-767-7676
Practice Address - Fax:787-764-9904
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR490225X00000X, 225XE1200X, 225XH1200X, 225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Not Answered225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation