Provider Demographics
NPI:1811720725
Name:GATHERS, ALEXIS DION (COTA/L)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:DION
Last Name:GATHERS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:DION
Other - Last Name:MCKELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:305 FALMOUTH TURNING
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-1426
Mailing Address - Country:US
Mailing Address - Phone:850-338-5948
Mailing Address - Fax:
Practice Address - Street 1:8500 EMERALD HILLS WAY
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-5662
Practice Address - Country:US
Practice Address - Phone:817-577-3337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218403224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant