Provider Demographics
NPI:1558129460
Name:ANDERSON, ALEXYS LORRAINE (OTRL)
Entity Type:Individual
Prefix:
First Name:ALEXYS
Middle Name:LORRAINE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1583 CAPAC RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48002-2402
Mailing Address - Country:US
Mailing Address - Phone:586-651-1345
Mailing Address - Fax:
Practice Address - Street 1:30701 BARRINGTON ST STE 150
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-5135
Practice Address - Country:US
Practice Address - Phone:248-965-3916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201013774225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist