1578680500 NPI number — MRS. ALISHA NICOLE NESBITT M.O.T., OTRL

Table of content: MRS. ALISHA NICOLE NESBITT M.O.T., OTRL (NPI 1578680500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578680500 NPI number — MRS. ALISHA NICOLE NESBITT M.O.T., OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NESBITT
Provider First Name:
ALISHA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.O.T., OTRL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORTON
Provider Other First Name:
ALISHA
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.O.T.,OTRL
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578680500
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5965 CURRY FORD RD
Provider Second Line Business Mailing Address:
APT# 305
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32822-4260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-682-2148
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5965 CURRY FORD RD
Provider Second Line Business Practice Location Address:
APT# 305
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32822-4260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-682-2148
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT12370 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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