Provider Demographics
NPI:1558680470
Name:BEARDEN, ALIVIA CONTI (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:ALIVIA
Middle Name:CONTI
Last Name:BEARDEN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:ALIVIA
Other - Middle Name:RACHAEL
Other - Last Name:CONTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:2603 KENSINGTON ALY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-2689
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4640 MARTIN ROAD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5571
Practice Address - Country:US
Practice Address - Phone:678-679-1261
Practice Address - Fax:678-250-9010
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005004225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics