Provider Demographics
NPI:1780857128
Name:WATSON, ALICIA ANNE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:ANNE
Last Name:WATSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 CIRCLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-2609
Mailing Address - Country:US
Mailing Address - Phone:501-661-9262
Mailing Address - Fax:
Practice Address - Street 1:2923 CIRCLEWOOD DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-2609
Practice Address - Country:US
Practice Address - Phone:501-661-9262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR765171W00000X, 172V00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No171W00000XOther Service ProvidersContractor
No172V00000XOther Service ProvidersCommunity Health Worker