Provider Demographics
NPI:1245786516
Name:BENSON, ALIVIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALIVIA
Middle Name:
Last Name:BENSON
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 1:200 RENAISSANCE PKWY NE APT 319
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2360
Mailing Address - Country:US
Mailing Address - Phone:901-512-8652
Mailing Address - Fax:
Practice Address - Street 1:1615 COBB PKWY NW
Practice Address - Street 2:APT 2007
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-2467
Practice Address - Country:US
Practice Address - Phone:901-512-8652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2020-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006468225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist