Provider Demographics
NPI:1679713051
Name:MENA, ALICIA CHRISTINE (OTR/L)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:CHRISTINE
Last Name:MENA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 JACKS CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351-7856
Mailing Address - Country:US
Mailing Address - Phone:928-284-0935
Mailing Address - Fax:
Practice Address - Street 1:505 JACKS CANYON RD
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-7856
Practice Address - Country:US
Practice Address - Phone:928-284-0935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1024225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ362153OtherAHCCCS
AZZ65523Medicare PIN