Provider Demographics
NPI:1174072920
Name:ALIPALA, FORTUNATO (OTR/L)
Entity type:Individual
Prefix:
First Name:FORTUNATO
Middle Name:
Last Name:ALIPALA
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:FORTUNE
Other - Middle Name:
Other - Last Name:ALIPALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:320 HIDDEN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-3274
Mailing Address - Country:US
Mailing Address - Phone:573-450-9652
Mailing Address - Fax:
Practice Address - Street 1:320 HIDDEN MEADOWS DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-3274
Practice Address - Country:US
Practice Address - Phone:573-450-9652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003761225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist