Provider Demographics
NPI:1790924041
Name:EXLEY, ALISSA L
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:L
Last Name:EXLEY
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 1:11900 N BAYSHORE DR
Mailing Address - Street 2:#4
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2927
Mailing Address - Country:US
Mailing Address - Phone:305-893-2566
Mailing Address - Fax:305-893-2566
Practice Address - Street 1:11900 N BAYSHORE DR
Practice Address - Street 2:#4
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2927
Practice Address - Country:US
Practice Address - Phone:305-893-2566
Practice Address - Fax:305-893-2566
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 9374225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist