Provider Demographics
NPI:1942740576
Name:HERMES, ALEXIS (OTR)
Entity Type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:
Last Name:HERMES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W RIVER WOODS PKWY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1024
Mailing Address - Country:US
Mailing Address - Phone:414-453-7418
Mailing Address - Fax:414-967-1151
Practice Address - Street 1:525 W RIVER WOODS PKWY
Practice Address - Street 2:SUITE 230
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212-1024
Practice Address - Country:US
Practice Address - Phone:414-453-7418
Practice Address - Fax:414-967-1151
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6041-26225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6041-26OtherWISCONSIN LICENSE