Provider Demographics
NPI:1215286380
Name:WHALLEY, ALEXIS NICOLE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:NICOLE
Last Name:WHALLEY
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:NICOLE
Other - Last Name:LILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:276 INDIAN PAINT BRUSH DR
Mailing Address - Street 2:UNIT R1111
Mailing Address - City:BANNER ELK
Mailing Address - State:NC
Mailing Address - Zip Code:28604-9879
Mailing Address - Country:US
Mailing Address - Phone:304-552-1144
Mailing Address - Fax:
Practice Address - Street 1:450 NEW MARKET BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5494
Practice Address - Country:US
Practice Address - Phone:828-355-9584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8412225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist