Alexis Elizabeth Theodore, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OTA5872 Issued in CA

Practice address

17042 Bellflower Blvd
Bellflower, CA 90706-5950

Phone

(562) 991-1324

Fax

(562) 502-9862

NPI assigned

May 27, 2022

Last updated

May 27, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1653609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653609600000",
    "number": "1669111712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 RIVAGE",
            "city": "NEWPORT COAST",
            "state": "CA",
            "postal_code": "926570100",
            "telephone_number": "970-599-0210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17042 BELLFLOWER BLVD",
            "city": "BELLFLOWER",
            "state": "CA",
            "postal_code": "907065950",
            "telephone_number": "562-991-1324",
            "fax_number": "562-502-9862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEODORE",
        "first_name": "ALEXIS",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-27",
        "last_updated": "2022-05-27",
        "certification_date": "2022-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "CA",
            "license": "OTA5872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nidhi Thareja, MD
• The Children's Dental Health Clinic
• The Childrens Clinic 'Serving Children and Their Families' (The Children's Clinic Family Health Center in Bellflower)
• The Healing Place - MTP, LLC
• The Psychiatric Team, Apmc
• Taelin Thibodeaux, CD(DONA)
• Christian Thiim, DO
• Jerly Thio, DMD
• Shaquinta Thomas Perez, LCSW
• Annalisa Barnett Thomas, LCSW

• Occupational Therapy Assistant in Bellflower, CA
• Providers in Bellflower, CA by specialty
• Occupational Therapy Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.