Provider Demographics
NPI:1417461617
Name:HART, ALEXIS (OT)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALNUT RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72476-1849
Mailing Address - Country:US
Mailing Address - Phone:870-637-5903
Mailing Address - Fax:870-637-5908
Practice Address - Street 1:700 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WALNUT RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72476-1849
Practice Address - Country:US
Practice Address - Phone:870-637-5903
Practice Address - Fax:870-637-5908
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTA1302224Z00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant