Provider Demographics
NPI:1053002691
Name:RAINE, ALEXANDRA ELISSE (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ELISSE
Last Name:RAINE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:ELISSE
Other - Last Name:PALACIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:15321 SW 74TH PL
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-2488
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15321 SW 74TH PL
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-2488
Practice Address - Country:US
Practice Address - Phone:305-965-0828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist