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General NPI Number Information
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NPI Number | 1043978521
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Entity Type | Organization
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Legal Business Name | AXXIS WELLNESS, INC.
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Dates
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Enumeration Date | 12/02/2021
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Last Update Date | 12/02/2021
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Provider Practice Location Address
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Address Line | 41 NORTH STREET
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City | HAMDEN
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State | CT
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Zip | 06514
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Country | US
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Telephone | 203-676-9114
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4089
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City | HAMDEN
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State | CT
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Zip | 06514-0089
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Country | US
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Telephone | 475-434-1672
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAJHMA BURROUGHS
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Credential | DHSC, MS, OTR/L
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Telephone | 475-434-1672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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