Provider Demographics
NPI:1861087371
Name:CHRISOS, ALEXA DOMINIQUE
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:DOMINIQUE
Last Name:CHRISOS
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 1:520 POWER PLANT CIR APT 302
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-4193
Mailing Address - Country:US
Mailing Address - Phone:704-281-5335
Mailing Address - Fax:
Practice Address - Street 1:520 POWER PLANT CIR APT 302
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-4193
Practice Address - Country:US
Practice Address - Phone:704-281-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist