Active NPI
Annaliese Luz Alicea, COTA
- Occupational Therapy Assistant
- Orlando, FL
National Provider Identifier
1013630805
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 19167
- Practice address
- 5165 Adanson St
Orlando, FL 32804-1331 - Phone
- (352) 394-0212
- Fax
- (352) 241-6361
- NPI assigned
- Sep 26, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 19167 | FL | Primary |
Addresses
Primary practice location
5165 Adanson St
Orlando, FL 32804-1331
Mailing address
PO Box 120547
Clermont, FL 34712-0547
Phone (352) 394-0212
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215017512 | Medicaid | FL |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | securerecords.orlando.html | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19167 | FL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664150400000",
"number": "1013630805",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 120547",
"city": "CLERMONT",
"state": "FL",
"postal_code": "347120547",
"telephone_number": "352-394-0212",
"fax_number": "352-241-6361"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5165 ADANSON ST",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328041331",
"telephone_number": "352-394-0212",
"fax_number": "352-241-6361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALICEA",
"first_name": "ANNALIESE",
"middle_name": "LUZ",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-26",
"last_updated": "2022-09-26",
"certification_date": "2022-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "FL",
"license": "19167",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1215017512",
"state": "FL"
}
],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "securerecords.orlando.html",
"affiliation": "N",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "securerecords",
"address_1": "5165 Adanson St",
"city": "Orlando",
"state": "FL",
"country_code": "US",
"postal_code": "328041331",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.