Provider Demographics
NPI:1063118792
Name:RASMUSSEN, ALICIA LOUISE
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:LOUISE
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:LOUISE
Other - Last Name:OROZCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:5555 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-8844
Mailing Address - Country:US
Mailing Address - Phone:707-481-2120
Mailing Address - Fax:
Practice Address - Street 1:5555 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-8844
Practice Address - Country:US
Practice Address - Phone:707-481-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21235225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA21235OtherCALIFORNIA BOARD OF OCCUPATIONAL THERAPY