Provider Demographics
NPI:1770619272
Name:CARUSO, ALICE (MA,OTR)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:CARUSO
Suffix:
Gender:F
Credentials:MA,OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 COPPERDALE LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2524
Mailing Address - Country:US
Mailing Address - Phone:631-385-7710
Mailing Address - Fax:
Practice Address - Street 1:23 COPPERDALE LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2524
Practice Address - Country:US
Practice Address - Phone:631-385-7710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000203-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist