Healthcare Provider Details

I. General information

NPI: 1346105889
Provider Name (Legal Business Name): ALEXIS PAIGE STAFFORD OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 STONEHENGE DR
CROSSVILLE TN
38558-6273
US

IV. Provider business mailing address

1048 ROLLING MEADOW DR
MT JULIET TN
37122-3682
US

V. Phone/Fax

Practice location:
  • Phone: 931-459-7646
  • Fax: 931-210-5079
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8550
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: