Provider Demographics
NPI:1821487893
Name:TERRY, ALEXIS BRIDGET (COTA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:BRIDGET
Last Name:TERRY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 LIVE OAK ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6733
Mailing Address - Country:US
Mailing Address - Phone:972-821-0050
Mailing Address - Fax:
Practice Address - Street 1:4200 LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6733
Practice Address - Country:US
Practice Address - Phone:972-821-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212893224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant