Provider Demographics
NPI:1710551080
Name:SYBROWSKY, ALEXA RAE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:RAE
Last Name:SYBROWSKY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5168 S MOOR MONT DR
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-6923
Mailing Address - Country:US
Mailing Address - Phone:801-633-0260
Mailing Address - Fax:
Practice Address - Street 1:417 S WAKARA WAY STE 1410
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1448
Practice Address - Country:US
Practice Address - Phone:801-585-6837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT75346094201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist