Provider Demographics
NPI:1245903020
Name:LAGRANDE, ALEXA (OTR/L)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:LAGRANDE
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 1:711 TROY SCHENECTADY RD STE 209
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2481
Mailing Address - Country:US
Mailing Address - Phone:518-786-1667
Mailing Address - Fax:
Practice Address - Street 1:711 TROY SCHENECTADY RD STE 216
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2461
Practice Address - Country:US
Practice Address - Phone:518-786-1665
Practice Address - Fax:518-785-0056
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025959225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07874702Medicaid