Provider Demographics
NPI:1730890609
Name:FAHR, ALEXIS RAE (COTA/L)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:RAE
Last Name:FAHR
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5649 ZION CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-7053
Mailing Address - Country:US
Mailing Address - Phone:209-406-5423
Mailing Address - Fax:
Practice Address - Street 1:970 BRANCHVIEW DR NE STE 160
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2234
Practice Address - Country:US
Practice Address - Phone:704-782-1322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15600224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant