Provider Demographics
NPI:1962037721
Name:ALEXANDRE, JACQUELINE (OTR)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:ALEXANDRE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 BREEZEWAY LOOP UNIT 232
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5079
Mailing Address - Country:US
Mailing Address - Phone:973-224-7227
Mailing Address - Fax:
Practice Address - Street 1:7205 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-7101
Practice Address - Country:US
Practice Address - Phone:321-972-3960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT20713225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist