Provider Demographics
NPI:1053882555
Name:LOPER, ALEXUS (MS)
Entity type:Individual
Prefix:
First Name:ALEXUS
Middle Name:
Last Name:LOPER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SHELLBARK WAY APT 22207
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-3705
Mailing Address - Country:US
Mailing Address - Phone:323-767-3072
Mailing Address - Fax:
Practice Address - Street 1:95 SKIDAWAY ISLAND PARK RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31411-1104
Practice Address - Country:US
Practice Address - Phone:800-889-6238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-09
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007071225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA225X00000XMedicaid