Healthcare Provider Details

I. General information

NPI: 1982516936
Provider Name (Legal Business Name): ALEXIS GEORGIA OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 LIBERTY ST STE 227
PELLA IA
50219-1776
US

IV. Provider business mailing address

604 LIBERTY ST STE 227
PELLA IA
50219-1776
US

V. Phone/Fax

Practice location:
  • Phone: 641-204-0046
  • Fax:
Mailing address:
  • Phone: 641-204-0046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number140892
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: