Provider Demographics
NPI:1336961168
Name:KING, ALEXIS ELLEANE (OTR/L)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ELLEANE
Last Name:KING
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 GAITHER RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-8370
Mailing Address - Country:US
Mailing Address - Phone:704-775-4660
Mailing Address - Fax:704-775-4466
Practice Address - Street 1:541 GAITHER RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-8370
Practice Address - Country:US
Practice Address - Phone:704-775-4660
Practice Address - Fax:704-775-4466
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7477225X00000X
NC17244225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty