Provider Demographics
NPI:1912390451
Name:HILLIARD, ALEXA RAE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:RAE
Last Name:HILLIARD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:RAE
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1069 WESSINGTON MANOR LN
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-7850
Mailing Address - Country:US
Mailing Address - Phone:859-816-0819
Mailing Address - Fax:
Practice Address - Street 1:2110 BEN CRAIG DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2301
Practice Address - Country:US
Practice Address - Phone:704-595-9363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9628225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics