Provider Demographics
NPI:1851868707
Name:COFFEY, ALICIA JEAN (MOTR/L)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:JEAN
Last Name:COFFEY
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MC COOL JUNCTION
Mailing Address - State:NE
Mailing Address - Zip Code:68401-8067
Mailing Address - Country:US
Mailing Address - Phone:402-366-2372
Mailing Address - Fax:
Practice Address - Street 1:2600 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-9637
Practice Address - Country:US
Practice Address - Phone:402-362-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2270225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist