Provider Demographics
NPI:1174187058
Name:WILLIAMS, ALEXIS ERVIN (OT)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ERVIN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:MARIE
Other - Last Name:ERVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1628 19TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-4832
Mailing Address - Country:US
Mailing Address - Phone:806-219-0500
Mailing Address - Fax:806-766-1286
Practice Address - Street 1:1628 19TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-4832
Practice Address - Country:US
Practice Address - Phone:806-219-0500
Practice Address - Fax:806-766-1286
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121567225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist