Provider Demographics
NPI:1275273161
Name:PROSINSKI, ALEXIS LEIGH (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:LEIGH
Last Name:PROSINSKI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 POWDER HORN RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-9013
Mailing Address - Country:US
Mailing Address - Phone:307-575-1415
Mailing Address - Fax:
Practice Address - Street 1:352 WHITNEY LN
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6489
Practice Address - Country:US
Practice Address - Phone:307-672-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT-1626225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist