Provider Demographics
NPI:1003203860
Name:OSMENT, ALEXIS MYERS
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MYERS
Last Name:OSMENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 HUBBARD CT
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-5842
Mailing Address - Country:US
Mailing Address - Phone:636-579-6810
Mailing Address - Fax:
Practice Address - Street 1:2007 HUBBARD CT
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-5842
Practice Address - Country:US
Practice Address - Phone:636-579-6810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT 0022532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer