Basic Information
| Provider Information | |||||||||
| NPI: | 1093155681 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERTZ | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.S. OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 ENGLEWOOD AVE | ||||||||
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| City: | BRIGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021357037 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 30 WARREN ST | ||||||||
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| City: | BRIGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021353602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172543800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2013 | ||||||||
| LastUpdateDate: | 06/27/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 10828 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.