Provider Demographics
NPI:1063649010
Name:D'ALESSANDRIS, IRENE N/A (COTA)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:N/A
Last Name:D'ALESSANDRIS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10403 SALVIA ST UNIT 104
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3947
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 LAKE VIEW DR.
Practice Address - Street 2:PINEVILLE REHAB
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134
Practice Address - Country:US
Practice Address - Phone:704-889-2271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5823172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker