Provider Demographics
NPI:1326698242
Name:GARRIS, ALEXANDRIA (MSOTR/L)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:GARRIS
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 ZION CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:NC
Mailing Address - Zip Code:27820-9442
Mailing Address - Country:US
Mailing Address - Phone:252-287-9237
Mailing Address - Fax:
Practice Address - Street 1:107 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-1719
Practice Address - Country:US
Practice Address - Phone:757-776-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119008342225X00000X
NC13400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist