Provider Demographics
NPI:1053756692
Name:CAST, ALICIA LENEE
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:LENEE
Last Name:CAST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3628 FIESTA WAY
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-6110
Mailing Address - Country:US
Mailing Address - Phone:513-594-0975
Mailing Address - Fax:
Practice Address - Street 1:3628 FIESTA WAY
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-6110
Practice Address - Country:US
Practice Address - Phone:513-594-0975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor