Provider Demographics
NPI:1891076220
Name:PHILLIPS, ALEXANDRA FAITH (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:FAITH
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4767 FRANKFORT HWY
Mailing Address - Street 2:
Mailing Address - City:RIDGELEY
Mailing Address - State:WV
Mailing Address - Zip Code:26753-7772
Mailing Address - Country:US
Mailing Address - Phone:304-738-4045
Mailing Address - Fax:304-738-4051
Practice Address - Street 1:957 NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-7356
Practice Address - Country:US
Practice Address - Phone:240-362-7718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1548225X00000X
MD07532225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist