Provider Demographics
NPI:1215269493
Name:BACHMAN, ALICIA DAWN (IECE)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:DAWN
Last Name:BACHMAN
Suffix:
Gender:F
Credentials:IECE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 YEALEY DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-9408
Mailing Address - Country:US
Mailing Address - Phone:859-803-2289
Mailing Address - Fax:859-647-2477
Practice Address - Street 1:5 YEALEY DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-9408
Practice Address - Country:US
Practice Address - Phone:859-803-2289
Practice Address - Fax:859-647-2477
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist