Provider Demographics
NPI:1154573863
Name:CICCEL, ALBERT HENRY JR (LO,C-PED,BOCOF)
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:HENRY
Last Name:CICCEL
Suffix:JR
Gender:M
Credentials:LO,C-PED,BOCOF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:7603 JACKSONVILLE CUTOFF RD APT B
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-3956
Mailing Address - Country:US
Mailing Address - Phone:501-257-1610
Mailing Address - Fax:501-257-1624
Practice Address - Street 1:2200 FORT ROOTS DR BLDG 89
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-1610
Practice Address - Fax:501-257-1624
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROPP00030222Z00000X
C17466225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter