Provider Demographics
NPI:1043624901
Name:WILKIE, ALEXIS
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:WILKIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 W BEARDSLEY RD
Mailing Address - Street 2:APT 2004
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5014
Mailing Address - Country:US
Mailing Address - Phone:623-815-4156
Mailing Address - Fax:
Practice Address - Street 1:4545 W BEARDSLEY RD
Practice Address - Street 2:APT 2004
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5014
Practice Address - Country:US
Practice Address - Phone:623-815-4156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5433225X00000X
VA0119006549225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5433OtherLICENSE