Provider Demographics
NPI:1730470733
Name:DEJIANNE, ALEXIS (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:DEJIANNE
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 LINDEN DR
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3536
Mailing Address - Country:US
Mailing Address - Phone:201-320-8873
Mailing Address - Fax:
Practice Address - Street 1:125 LINDEN DR
Practice Address - Street 2:
Practice Address - City:FAIR HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:07704-3536
Practice Address - Country:US
Practice Address - Phone:201-320-8873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00334400225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics