Provider Demographics
NPI:1538928973
Name:LAURENT, ALEXIS (MOTR/L)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:LAURENT
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1409
Mailing Address - Country:US
Mailing Address - Phone:763-682-7774
Mailing Address - Fax:
Practice Address - Street 1:12 1ST AVE S
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1409
Practice Address - Country:US
Practice Address - Phone:763-682-7774
Practice Address - Fax:763-682-2312
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN107384225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist