Provider Demographics
NPI:1285020289
Name:MATTHEWS, ALEXANDRA
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:VENERIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08701
Mailing Address - Country:US
Mailing Address - Phone:215-839-6144
Mailing Address - Fax:
Practice Address - Street 1:40 AIRPORT RD.
Practice Address - Street 2:
Practice Address - City:LAKEWOOD TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08701
Practice Address - Country:US
Practice Address - Phone:215-839-6144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2016-05-19
Deactivation Date:2015-07-14
Deactivation Code:
Reactivation Date:2016-05-18
Provider Licenses
StateLicense IDTaxonomies
PAOC013786225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist