Provider Demographics
NPI:1952582819
Name:PRINCE, ALAN D (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:D
Last Name:PRINCE
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 SANTO TOMAS CT
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-1465
Mailing Address - Country:US
Mailing Address - Phone:805-574-4062
Mailing Address - Fax:
Practice Address - Street 1:1233 SANTO TOMAS CT
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-1465
Practice Address - Country:US
Practice Address - Phone:805-574-4062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4431225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist