Individual
ALICIA F LEWALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
590 HISTORIC HIGHWAY 441, SUITE E, DEMOREST, GA 30535-4561
(706) 754-6611
(706) 754-5834
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 954-7408
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT1729
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT001729
OCCUPATIONAL THERAPY
GA
Enumeration date
09/05/2006
Last updated
02/12/2014
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