Provider Demographics
NPI:1194890723
Name:PHILLIPS, ALICE C (OTR L)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:C
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:MS
Other - First Name:ALICE
Other - Middle Name:
Other - Last Name:CHARLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4223 AREHART DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-8013
Mailing Address - Country:US
Mailing Address - Phone:501-562-2184
Mailing Address - Fax:
Practice Address - Street 1:1 TREASURE HILL RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2219
Practice Address - Country:US
Practice Address - Phone:501-223-8996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR127174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist