Provider Demographics
NPI:1407607963
Name:RENFRO, ALEXIS MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARIE
Last Name:RENFRO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:MARIE
Other - Last Name:STREETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:348 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-1193
Mailing Address - Country:US
Mailing Address - Phone:785-571-3802
Mailing Address - Fax:
Practice Address - Street 1:2300 N 113TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-3786
Practice Address - Country:US
Practice Address - Phone:785-571-3802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-03845225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist