Provider Demographics
NPI:1316052608
Name:O'TOOLE, ALICIA J (MPT)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:J
Last Name:O'TOOLE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6354 US ROUTE 60 E STE 4
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1247
Mailing Address - Country:US
Mailing Address - Phone:304-733-1626
Mailing Address - Fax:304-733-2012
Practice Address - Street 1:6354 US ROUTE 60 E STE 4
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1247
Practice Address - Country:US
Practice Address - Phone:304-733-1626
Practice Address - Fax:304-733-2012
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist