Provider Demographics
NPI:1245874908
Name:MAGOON, ALICIA ANNE (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:ANNE
Last Name:MAGOON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:ANNE
Other - Last Name:LOTFEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:P.O BOX 1921
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03866
Mailing Address - Country:US
Mailing Address - Phone:603-332-2848
Mailing Address - Fax:603-330-0838
Practice Address - Street 1:105 EASTERN AVENUE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867
Practice Address - Country:US
Practice Address - Phone:603-332-2848
Practice Address - Fax:603-330-0838
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT3317225X00000X
NH2668225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist