Provider Demographics
NPI:1790008696
Name:LEWSEY, ALICE
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:LEWSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 MELBOURNE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5767
Mailing Address - Country:US
Mailing Address - Phone:925-560-1125
Mailing Address - Fax:
Practice Address - Street 1:125 RYAN INDUSTRIAL CT STE 205
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1772
Practice Address - Country:US
Practice Address - Phone:925-855-9810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT# 1011225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics