Healthcare Provider Details

I. General information

NPI: 1043137763
Provider Name (Legal Business Name): ALEXANDRA GRACE SHOWS OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 MURPHY BLVD
GAINESVILLE GA
30504-6002
US

IV. Provider business mailing address

4623 BABBLING CREEK WAY
GAINESVILLE GA
30506-7500
US

V. Phone/Fax

Practice location:
  • Phone: 770-535-8372
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: