Healthcare Provider Details

I. General information

NPI: 1447185871
Provider Name (Legal Business Name): ALICE BELLE WILMER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 OLD NORCROSS RD STE 100
LAWRENCEVILLE GA
30046-3390
US

IV. Provider business mailing address

2692 OLD NORCROSS RD
TUCKER GA
30084-3130
US

V. Phone/Fax

Practice location:
  • Phone: 678-528-5025
  • Fax: 678-377-2882
Mailing address:
  • Phone: 678-373-2505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT001022
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: