MEDICARE: SHANISE MARIE ALEXANDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XM0800X	Mental Health Occupational Therapist

General Provider Information

NPI Number	:	1366082471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANISE MARIE ALEXANDER

Provider Business Mailing Address
First Line	:	510 S 10TH ST APT A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-7044
Country	:	US
Telephone Number	:	702-462-6630
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 S 10TH ST APT A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-7044
Country	:	US
Telephone Number	:	702-462-6630
Fax Number	:	702-462-6634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2020
Last Update Date	:	01/07/2020

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Directions to “ SHANISE MARIE ALEXANDER ” Practice Location

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