Provider Demographics
NPI:1881403111
Name:HABERER, ALEXA (OTR/L)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:HABERER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710 GRISSOM CT
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047-9563
Mailing Address - Country:US
Mailing Address - Phone:716-829-9721
Mailing Address - Fax:
Practice Address - Street 1:51 SAINT JOHNS PARKSIDE ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14210-2515
Practice Address - Country:US
Practice Address - Phone:716-829-9721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-02
Last Update Date:2025-04-22
Deactivation Date:2025-03-28
Deactivation Code:
Reactivation Date:2025-04-21
Provider Licenses
StateLicense IDTaxonomies
NY03002401225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics