Provider Demographics
NPI:1790013944
Name:ALEXIN, CARRIE RENAE
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:RENAE
Last Name:ALEXIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6923
Mailing Address - Country:US
Mailing Address - Phone:405-321-1469
Mailing Address - Fax:405-321-1379
Practice Address - Street 1:1106 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6923
Practice Address - Country:US
Practice Address - Phone:405-321-1469
Practice Address - Fax:405-321-1379
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1795225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant