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General NPI Number Information
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NPI Number | 1760185466
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Entity Type | Individual
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Provider Name | ALEXIS MARIE WAUN OTRL
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Gender | Female
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Dates
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Enumeration Date | 03/23/2023
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 1100 S. VAN DYKE RD.
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City | BAD AXE
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State | MI
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Zip | 48413
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Country | US
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Telephone | 989-269-1540
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 S VAN DYKE RD
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City | BAD AXE
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State | MI
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Zip | 48413-9615
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Country | US
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Telephone | 989-479-9255
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 5201013270
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License Number State | MI
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