Healthcare Provider Details

I. General information

NPI: 1134045115
Provider Name (Legal Business Name): ALEXANDRIA NICOLE MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 BANKTON CIR
HANAHAN SC
29410-2957
US

IV. Provider business mailing address

9 S ANDERSON AVE APT C
CHARLESTON SC
29412-3760
US

V. Phone/Fax

Practice location:
  • Phone: 877-407-3422
  • Fax:
Mailing address:
  • Phone: 704-408-1391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8012
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: