Provider Demographics
NPI:1093039323
Name:ALEXANDER, KAMELY KEISHA (OTA/L)
Entity Type:Individual
Prefix:MISS
First Name:KAMELY
Middle Name:KEISHA
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 LEFFERTS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-4549
Mailing Address - Country:US
Mailing Address - Phone:718-484-7806
Mailing Address - Fax:347-435-3172
Practice Address - Street 1:236 NEPTUNE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6302
Practice Address - Country:US
Practice Address - Phone:718-769-2698
Practice Address - Fax:718-943-7035
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006757171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006757Medicare Oscar/Certification