Provider Demographics
NPI:1568743888
Name:BIALKE, ALEXANDRA MINDY MARISE (MA, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA MINDY
Middle Name:MARISE
Last Name:BIALKE
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:MRS
Other - First Name:ALEXANDRA MINDY
Other - Middle Name:MARISE
Other - Last Name:BOOTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, OTR/L
Mailing Address - Street 1:400 DOANSBURG RD
Mailing Address - Street 2:BOX 719, GREEN CHIMNEYS
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-5902
Mailing Address - Country:US
Mailing Address - Phone:845-279-2995
Mailing Address - Fax:845-279-3077
Practice Address - Street 1:400 DOANSBURG RD
Practice Address - Street 2:BOX 719, GREEN CHIMNEYS
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-5902
Practice Address - Country:US
Practice Address - Phone:845-279-2995
Practice Address - Fax:845-279-3077
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016702-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist