Provider Demographics
NPI:1174003693
Name:KING, ALEXXIS S
Entity Type:Individual
Prefix:
First Name:ALEXXIS
Middle Name:S
Last Name:KING
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 1:7720 WALL TRIANA HWY
Mailing Address - Street 2:
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-4816
Mailing Address - Country:US
Mailing Address - Phone:256-683-1088
Mailing Address - Fax:
Practice Address - Street 1:500 SAINT CLAIR AVE SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5021
Practice Address - Country:US
Practice Address - Phone:256-539-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006780225X00000X
AL4331225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist