Provider Demographics
NPI:1821687104
Name:PHELPS, ALEXANDRIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:PHELPS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ALEXANDRIA
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:815 TRIPLETT ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3564
Mailing Address - Country:US
Mailing Address - Phone:270-683-4517
Mailing Address - Fax:270-852-1491
Practice Address - Street 1:815 TRIPLETT ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3564
Practice Address - Country:US
Practice Address - Phone:270-683-4517
Practice Address - Fax:270-852-1491
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY267081225XP0200X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics