Provider Demographics
NPI:1629891874
Name:GOTTFRIED, ALICIA ERIN (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ERIN
Last Name:GOTTFRIED
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 E HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OH
Mailing Address - Zip Code:45810-1120
Mailing Address - Country:US
Mailing Address - Phone:419-634-8655
Mailing Address - Fax:419-634-0402
Practice Address - Street 1:118 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OH
Practice Address - Zip Code:45810-1120
Practice Address - Country:US
Practice Address - Phone:419-634-8655
Practice Address - Fax:419-634-0402
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT008693225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist