Healthcare Provider Details

I. General information

NPI: 1699524678
Provider Name (Legal Business Name): ALEXA MARY LYVERS MSOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 FITCH AVE
DARIEN CT
06820-5334
US

IV. Provider business mailing address

27 FITCH AVE
DARIEN CT
06820-5334
US

V. Phone/Fax

Practice location:
  • Phone: 908-246-1027
  • Fax:
Mailing address:
  • Phone: 908-246-1027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number021700
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number48.006150
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: