Provider Demographics
NPI:1770082646
Name:PERRAM, ALYXANDRA MARIE
Entity type:Individual
Prefix:
First Name:ALYXANDRA
Middle Name:MARIE
Last Name:PERRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4816 E BAYSHORE RD
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-3910
Mailing Address - Country:US
Mailing Address - Phone:419-341-9643
Mailing Address - Fax:
Practice Address - Street 1:4816 E BAYSHORE RD
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-3910
Practice Address - Country:US
Practice Address - Phone:419-341-9643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer