Healthcare Provider Details

I. General information

NPI: 1861217531
Provider Name (Legal Business Name): ALEXIS OTWORTH-WHITE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MARIETTA RD
CHILLICOTHEE OH
45601-9433
US

IV. Provider business mailing address

869 ORANGE ST
CHILLICOTHEE OH
45601-1341
US

V. Phone/Fax

Practice location:
  • Phone: 740-772-5900
  • Fax:
Mailing address:
  • Phone: 740-804-7926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT011407
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: