Albert Henry Ciccel Jr., LO,C-PED,BOCOF

Primary specialty

OrthotistTaxonomy code 222Z00000X

License

OPP00030 Issued in AR

Practice address

2200 Fort Roots Dr BLDG 89
North Little Rock, AR 72114-1709

Phone

(501) 257-1610

Fax

(501) 257-1624

NPI assigned

Oct 14, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1223942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1223942400000",
    "number": "1154573863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7603 JACKSONVILLE CUTOFF RD APT B",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "720763956",
            "telephone_number": "501-257-1610",
            "fax_number": "501-257-1624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 FORT ROOTS DR BLDG 89",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721141709",
            "telephone_number": "501-257-1610",
            "fax_number": "501-257-1624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CICCEL",
        "first_name": "ALBERT",
        "middle_name": "HENRY",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LO,C-PED,BOCOF",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-10-14",
        "last_updated": "2008-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": "AR",
            "license": "OPP00030",
            "primary": true
        },
        {
            "code": "225000000X",
            "taxonomy_group": "",
            "desc": "Orthotic Fitter",
            "state": null,
            "license": "C17466",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tommy D Chu, MD
• Shelley L Chumley, SLP
• Willard T Chumley, MD
• Katherine Sarah Church
• Michael C Church, M.D.
• Laura Cima, PHARMD
• Zadie Clairday
• Carsten Clark
• Caylee Rayanne Clark
• Kristin Dumboski Clark, DDS, MS

• All providers in North Little Rock, AR
• Orthotist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.