Provider Demographics
NPI:1235816299
Name:MARSELLOS, ALEXA (MT-BC)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:MARSELLOS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21428 SW 85TH PATH
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-7380
Mailing Address - Country:US
Mailing Address - Phone:786-383-3292
Mailing Address - Fax:
Practice Address - Street 1:21428 SW 85TH PATH
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-7380
Practice Address - Country:US
Practice Address - Phone:786-383-3292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17144225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist