Provider Demographics
NPI:1053849968
Name:MARSTON, ALEXANDRA L (OT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:L
Last Name:MARSTON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:L
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7000 SPYGLASS CT STE 120
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7948
Mailing Address - Country:US
Mailing Address - Phone:321-241-6543
Mailing Address - Fax:321-241-6513
Practice Address - Street 1:7000 SPYGLASS CT STE 120
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7948
Practice Address - Country:US
Practice Address - Phone:321-241-6543
Practice Address - Fax:321-241-6513
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18508225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist