Provider Demographics
NPI:1043978521
Name:AXXIS WELLNESS, INC.
Entity Type:Organization
Organization Name:AXXIS WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAJHMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURROUGHS
Authorized Official - Suffix:
Authorized Official - Credentials:DHSC, MS, OTR/L
Authorized Official - Phone:475-434-1672
Mailing Address - Street 1:PO BOX 4089
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-0089
Mailing Address - Country:US
Mailing Address - Phone:475-434-1672
Mailing Address - Fax:
Practice Address - Street 1:41 NORTH STREET
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514
Practice Address - Country:US
Practice Address - Phone:203-676-9114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty