Provider Demographics
NPI:1780036962
Name:ALEXIS, DOMINIQUE YVETTE (MOTR/L)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:YVETTE
Last Name:ALEXIS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5690 ATLANTIC AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8217
Mailing Address - Country:US
Mailing Address - Phone:786-390-6614
Mailing Address - Fax:
Practice Address - Street 1:5690 ATLANTIC AVE APT 204
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8217
Practice Address - Country:US
Practice Address - Phone:786-390-6614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2021-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist