Healthcare Provider Details

I. General information

NPI: 1619802279
Provider Name (Legal Business Name): ALEXANDRIA NICOLE SMALLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

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

350 AUSTIN GRAYBILL RD
NORTH AUGUSTA SC
29860-9251
US

IV. Provider business mailing address

611 CLIMBING ROSE BLVD APT E
GRANITEVILLE SC
29829-4110
US

V. Phone/Fax

Practice location:
  • Phone: 803-278-4272
  • Fax:
Mailing address:
  • Phone: 803-514-6407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA.5521
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: