Provider Demographics
NPI:1881257095
Name:PALAZZOLO, ALEXXA (MOTRL)
Entity type:Individual
Prefix:
First Name:ALEXXA
Middle Name:
Last Name:PALAZZOLO
Suffix:
Gender:F
Credentials:MOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56420 CHESAPEAKE TRL
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-5041
Mailing Address - Country:US
Mailing Address - Phone:586-321-6910
Mailing Address - Fax:
Practice Address - Street 1:30801 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-1732
Practice Address - Country:US
Practice Address - Phone:586-293-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010557225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty