Provider Demographics
NPI:1063666188
Name:OTERO, ALICIA ANA (MA; CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:ANA
Last Name:OTERO
Suffix:
Gender:F
Credentials:MA; CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 TAVERNIER DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-0677
Mailing Address - Country:US
Mailing Address - Phone:904-844-3136
Mailing Address - Fax:904-789-6295
Practice Address - Street 1:30 TAVERNIER DR UNIT B
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-0677
Practice Address - Country:US
Practice Address - Phone:904-404-2345
Practice Address - Fax:904-789-6295
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017816235Z00000X
FLSA20931235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist