Provider Demographics
NPI:1457039679
Name:MASSINGILL, ALEXANDREA P (COTA/L)
Entity Type:Individual
Prefix:
First Name:ALEXANDREA
Middle Name:P
Last Name:MASSINGILL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 BANDY ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:GA
Mailing Address - Zip Code:30728-4335
Mailing Address - Country:US
Mailing Address - Phone:706-767-1009
Mailing Address - Fax:
Practice Address - Street 1:2470 DUG GAP RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-9210
Practice Address - Country:US
Practice Address - Phone:706-810-5980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001652224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant