Provider Demographics
NPI:1396564837
Name:PRICE, ALEXANDRIA (OTR)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRIA
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:ALEXANDRIA
Other - Middle Name:
Other - Last Name:LEVY-BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:523 ELLERBE WAY
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-6119
Mailing Address - Country:US
Mailing Address - Phone:813-704-9385
Mailing Address - Fax:
Practice Address - Street 1:765 W GRANT ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-6810
Practice Address - Country:US
Practice Address - Phone:813-743-3701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24246225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist