Provider Demographics
NPI:1710755442
Name:DESTRAMPE, ALEXA (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:DESTRAMPE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 LEAR LN APT 3
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-2779
Mailing Address - Country:US
Mailing Address - Phone:906-370-6805
Mailing Address - Fax:
Practice Address - Street 1:1268 LEAR LN APT 3
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-2779
Practice Address - Country:US
Practice Address - Phone:906-370-6805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8453-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist