Basic Information
| Provider Information | |||||||||
| NPI: | 1275195893 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEBLANC | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | OTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 98 CUSHMAN DR | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060422314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609924299 | ||||||||
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| Practice Location | |||||||||
| Address1: | 66 BROAD ST | ||||||||
| Address2: | |||||||||
| City: | WESTFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010852927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135625464 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2019 | ||||||||
| LastUpdateDate: | 07/03/2019 | ||||||||
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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 | 224Z00000X | 1987 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.