Healthcare Provider Details

I. General information

NPI: 1417834029
Provider Name (Legal Business Name): ALISHA CAGLE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 HADLEIGH DR
LEXINGTON SC
29072-9741
US

IV. Provider business mailing address

205 HADLEIGH DR
LEXINGTON SC
29072-9741
US

V. Phone/Fax

Practice location:
  • Phone: 803-743-6007
  • Fax:
Mailing address:
  • Phone: 803-743-6007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3741
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: