Provider Demographics
NPI:1932716941
Name:DE LA RUA, ALEXANDRA ANITA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:ANITA
Last Name:DE LA RUA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1901 DORSET DRIVE
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591
Mailing Address - Country:US
Mailing Address - Phone:845-689-4183
Mailing Address - Fax:
Practice Address - Street 1:675 THIRD AVENUE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:212-922-1001
Practice Address - Fax:212-922-0033
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY024747225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics