Provider Demographics
NPI:1740936608
Name:BIGELOW, ALICIA GRACE
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:GRACE
Last Name:BIGELOW
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 1:108 FARMHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-1742
Mailing Address - Country:US
Mailing Address - Phone:267-644-5965
Mailing Address - Fax:
Practice Address - Street 1:1628 BUTLER PIKE
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1227
Practice Address - Country:US
Practice Address - Phone:610-832-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC018321225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist