Provider Demographics
NPI:1295177509
Name:NANCE, ALICIA LYNN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:LYNN
Last Name:NANCE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:ALICIA
Other - Middle Name:LYNN
Other - Last Name:NANCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:410 NEW BRIDGE ST
Mailing Address - Street 2:SUITE 10-A
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-4739
Mailing Address - Country:US
Mailing Address - Phone:910-347-2212
Mailing Address - Fax:910-347-6003
Practice Address - Street 1:410 NEW BRIDGE ST
Practice Address - Street 2:SUITE 10-A
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-4739
Practice Address - Country:US
Practice Address - Phone:910-347-2212
Practice Address - Fax:910-347-6003
Is Sole Proprietor?:No
Enumeration Date:2013-07-28
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8437225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics