Healthcare Provider Details

I. General information

NPI: 1770746729
Provider Name (Legal Business Name): ALEXIS VENTIMGLIA NAJARRO OTR/L, CPAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXIS VENTIMGLIA OTR/L

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 SAMS ST STE A
DECATUR GA
30030-4101
US

IV. Provider business mailing address

141 SAMS ST STE A
DECATUR GA
30030-4101
US

V. Phone/Fax

Practice location:
  • Phone: 404-296-8511
  • Fax: 404-296-8514
Mailing address:
  • Phone: 404-296-8511
  • Fax: 404-296-8514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT004944
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT004944
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT004944
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: