Provider Demographics
NPI:1588800908
Name:ALCALA, BERNADETTE B (MS OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:B
Last Name:ALCALA
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 1:4130 BAXTER TRL
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8384
Mailing Address - Country:US
Mailing Address - Phone:678-765-0744
Mailing Address - Fax:
Practice Address - Street 1:5991 PARKWAY NORTH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-1342
Practice Address - Country:US
Practice Address - Phone:770-205-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004865225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist