Provider Demographics
NPI:1992347363
Name:CASARES, ALEXA MARY (MS, OTR/L, ASDCS)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:MARY
Last Name:CASARES
Suffix:
Gender:F
Credentials:MS, OTR/L, ASDCS
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:MARY
Other - Last Name:FEDUCHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3044 DUE WEST RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-2125
Mailing Address - Country:US
Mailing Address - Phone:770-443-9672
Mailing Address - Fax:
Practice Address - Street 1:3044 DUE WEST RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-2125
Practice Address - Country:US
Practice Address - Phone:770-443-9672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-17
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007549225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist