Provider Demographics
NPI:1679297766
Name:SPILLMAN, LEXIS ELIZABETH ANN (COTA/L)
Entity type:Individual
Prefix:
First Name:LEXIS
Middle Name:ELIZABETH ANN
Last Name:SPILLMAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:LEXIS
Other - Middle Name:ELIZABETH ANN
Other - Last Name:SPILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 FINCH RD
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-6142
Mailing Address - Country:US
Mailing Address - Phone:870-335-5233
Mailing Address - Fax:
Practice Address - Street 1:2402 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-1963
Practice Address - Country:US
Practice Address - Phone:870-236-8771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1876224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant