Provider Demographics
NPI:1083977078
Name:SALLA, ALICIA TREESH (MOT,OTR/L)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:TREESH
Last Name:SALLA
Suffix:
Gender:F
Credentials:MOT,OTR/L
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:TREESH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:117 COXE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-6755
Mailing Address - Country:US
Mailing Address - Phone:574-527-5193
Mailing Address - Fax:
Practice Address - Street 1:1180 HAYWOOD RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-2286
Practice Address - Country:US
Practice Address - Phone:864-631-2537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004946A225X00000X
SC3891225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist