Provider Demographics
NPI:1972659126
Name:WEBBER, ALICIA MARIE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:MARIE
Last Name:WEBBER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:ALICIA
Other - Middle Name:MARIE
Other - Last Name:SNELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:624 SIDON RD
Mailing Address - Street 2:
Mailing Address - City:ROSE BUD
Mailing Address - State:AR
Mailing Address - Zip Code:72137-9775
Mailing Address - Country:US
Mailing Address - Phone:501-278-0790
Mailing Address - Fax:
Practice Address - Street 1:2501 E MOORE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4751
Practice Address - Country:US
Practice Address - Phone:501-268-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1555225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U926OtherOCCUPATIONAL THERAPIST
AR140130721Medicaid