Provider Demographics
NPI:1972024321
Name:DELAYO, ALEXANDRA VICTORIA (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:VICTORIA
Last Name:DELAYO
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HOLDEN ST UNIT 2224
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-5792
Mailing Address - Country:US
Mailing Address - Phone:908-577-4082
Mailing Address - Fax:
Practice Address - Street 1:765 ALLENS AVE STE 200
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-5443
Practice Address - Country:US
Practice Address - Phone:401-432-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT01653225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist