Provider Demographics
NPI:1962908707
Name:DICLEMENTI, ALICIA M (OTR/L)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:DICLEMENTI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:M
Other - Last Name:ANTICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:226 NEWGATE RD
Mailing Address - Street 2:
Mailing Address - City:EAST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06026-9557
Mailing Address - Country:US
Mailing Address - Phone:413-335-9046
Mailing Address - Fax:
Practice Address - Street 1:304 MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2985
Practice Address - Country:US
Practice Address - Phone:860-674-1824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT5748225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program