Provider Demographics
NPI:1730988932
Name:HANKS, ALEXIS DIANE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:DIANE
Last Name:HANKS
Suffix:
Gender:
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 BELLA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-7857
Mailing Address - Country:US
Mailing Address - Phone:573-225-4294
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 480
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65102-0480
Practice Address - Country:US
Practice Address - Phone:573-225-4294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025006726225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist