Provider Demographics
NPI:1104286939
Name:BAXTER, ALISHA E (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:E
Last Name:BAXTER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 GROVE DR NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-6397
Mailing Address - Country:US
Mailing Address - Phone:404-434-8354
Mailing Address - Fax:888-865-4646
Practice Address - Street 1:4445 GROVE DR NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-6397
Practice Address - Country:US
Practice Address - Phone:404-434-8354
Practice Address - Fax:888-865-4646
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006416225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics