Provider Demographics
NPI:1285059139
Name:ERWIN, ALEXA LEIGH (COTA)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:LEIGH
Last Name:ERWIN
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 1:16680 HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:KENO
Mailing Address - State:OR
Mailing Address - Zip Code:97627-9726
Mailing Address - Country:US
Mailing Address - Phone:620-388-0764
Mailing Address - Fax:
Practice Address - Street 1:1401 BRYANT WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-7151
Practice Address - Country:US
Practice Address - Phone:541-882-6691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-02
Last Update Date:2014-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR295582224Z00000X
KS1800844224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant