Provider Demographics
NPI:1770126088
Name:KOREIVO, ALEXANDRA A (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:A
Last Name:KOREIVO
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 1:48 ACORN ST
Mailing Address - Street 2:
Mailing Address - City:STANHOPE
Mailing Address - State:NJ
Mailing Address - Zip Code:07874-3423
Mailing Address - Country:US
Mailing Address - Phone:973-903-6541
Mailing Address - Fax:
Practice Address - Street 1:706 W BEN WHITE BLVD STE A150
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-8128
Practice Address - Country:US
Practice Address - Phone:512-441-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120290225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist