Provider Demographics
NPI:1174720122
Name:CORREA, ALICIA RENE (OT)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:RENE
Last Name:CORREA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:RENE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1025 BREVARD RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-8562
Mailing Address - Country:US
Mailing Address - Phone:828-670-8056
Mailing Address - Fax:828-670-8057
Practice Address - Street 1:1025 BREVARD RD
Practice Address - Street 2:SUITE 10
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-8562
Practice Address - Country:US
Practice Address - Phone:828-670-8056
Practice Address - Fax:828-670-8057
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009638-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7302046Medicaid
NC147RGOtherBLUE CROSS BLUE SHIELD