Provider Demographics
NPI:1831654748
Name:MCCARRON, ALEXIS TAYLOR
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:TAYLOR
Last Name:MCCARRON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ALEXIS
Other - Middle Name:TAYLOR
Other - Last Name:MCCARRON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:742 NAAMANS RD
Mailing Address - Street 2:
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-1610
Mailing Address - Country:US
Mailing Address - Phone:302-584-5989
Mailing Address - Fax:
Practice Address - Street 1:742 NAAMANS RD
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-1610
Practice Address - Country:US
Practice Address - Phone:302-584-5989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2255A2300X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer