Healthcare Provider Details

I. General information

NPI: 1821687104
Provider Name (Legal Business Name): ALEXANDRIA PHELPS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXANDRIA COOPER

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 TRIPLETT ST
OWENSBORO KY
42303-3564
US

IV. Provider business mailing address

815 TRIPLETT ST
OWENSBORO KY
42303-3564
US

V. Phone/Fax

Practice location:
  • Phone: 270-683-4517
  • Fax: 270-852-1491
Mailing address:
  • Phone: 270-683-4517
  • Fax: 270-852-1491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number267081
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: