Provider Demographics
NPI:1982779138
Name:ALIX, MARJORIE M (OT)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:M
Last Name:ALIX
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 POST RD E
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-5200
Mailing Address - Country:US
Mailing Address - Phone:203-341-0488
Mailing Address - Fax:203-227-8809
Practice Address - Street 1:728 POST RD E
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5200
Practice Address - Country:US
Practice Address - Phone:203-341-0488
Practice Address - Fax:203-227-8809
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001687225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist