Provider Demographics
NPI:1942855093
Name:CLAPP, ALEXA KATHERINE (MS OTRL)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:KATHERINE
Last Name:CLAPP
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:KATHERINE
Other - Last Name:RENCIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTRL
Mailing Address - Street 1:417 MILL ST APT 3
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348-1528
Mailing Address - Country:US
Mailing Address - Phone:616-240-6462
Mailing Address - Fax:
Practice Address - Street 1:145 S MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-1702
Practice Address - Country:US
Practice Address - Phone:269-792-2353
Practice Address - Fax:269-792-2847
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010604225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1699047050OtherTYPE 2 NPI
MIMI5239Medicaid