Provider Demographics
NPI:1457078834
Name:HANLEY, ALEXA NICOLE (OTD)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:NICOLE
Last Name:HANLEY
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 ASHLEY TOWN CENTER DR APT 635
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5692
Mailing Address - Country:US
Mailing Address - Phone:347-683-0279
Mailing Address - Fax:
Practice Address - Street 1:85C VINCENT DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4030
Practice Address - Country:US
Practice Address - Phone:843-822-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6516225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist