Provider Demographics
NPI:1104055763
Name:DENNIS, ALESLIE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ALESLIE
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 COLLINGWOOD LNDG
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-7433
Mailing Address - Country:US
Mailing Address - Phone:678-548-3556
Mailing Address - Fax:770-728-0229
Practice Address - Street 1:15 COLLINGWOOD LNDG
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-7433
Practice Address - Country:US
Practice Address - Phone:678-548-3556
Practice Address - Fax:770-728-0229
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-03
Last Update Date:2009-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004362225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist