Provider Demographics
NPI:1457820722
Name:HEAD, ALISHA DENISE (COTA)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:DENISE
Last Name:HEAD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 BOGGY RD
Mailing Address - Street 2:
Mailing Address - City:WASKOM
Mailing Address - State:TX
Mailing Address - Zip Code:75692-7441
Mailing Address - Country:US
Mailing Address - Phone:903-926-8132
Mailing Address - Fax:
Practice Address - Street 1:658 BOGGY RD
Practice Address - Street 2:
Practice Address - City:WASKOM
Practice Address - State:TX
Practice Address - Zip Code:75692-7441
Practice Address - Country:US
Practice Address - Phone:903-926-8132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210343224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant