Provider Demographics
NPI:1063270809
Name:GERDES, ALEXA BRIANNE (OTR/L)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:BRIANNE
Last Name:GERDES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LEXI
Other - Middle Name:
Other - Last Name:GERDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1102 WILSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-6470
Mailing Address - Country:US
Mailing Address - Phone:224-639-5028
Mailing Address - Fax:
Practice Address - Street 1:1638 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3602
Practice Address - Country:US
Practice Address - Phone:877-486-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.015847225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist