Provider Demographics
NPI:1750580387
Name:ALEXIS, MARY (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:ALEXIS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-4817
Mailing Address - Country:US
Mailing Address - Phone:717-258-6675
Mailing Address - Fax:
Practice Address - Street 1:220 WILSON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3697
Practice Address - Country:US
Practice Address - Phone:717-245-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009566225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist