Individual
ROLANDO ALICEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
6040 LUTE RD, PORTAGE, IN 46368-5008
(219) 763-6858
(219) 763-4858
Mailing address
1500 STATE ST, HOBART, IN 46342
(219) 942-9571
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32001127A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32001127A
COTA
IN
Enumeration date
07/30/2007
Last updated
07/30/2007
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