Provider Demographics
NPI:1396598181
Name:KEHL, ALEXIS (COTA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:KEHL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:KEHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2503 RAVENSWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704
Mailing Address - Country:US
Mailing Address - Phone:479-276-9517
Mailing Address - Fax:
Practice Address - Street 1:2070 MCKENZIE RD STE C
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0870
Practice Address - Country:US
Practice Address - Phone:479-750-7778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1972224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant