Healthcare Provider Details

I. General information

NPI: 1407596000
Provider Name (Legal Business Name): ALEXIS DIANE ELIZABETH RITCHEA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 03/31/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SAND LAKE RD
ORLANDO FL
32809-7681
US

IV. Provider business mailing address

1650 SAND LAKE RD
ORLANDO FL
32809-7681
US

V. Phone/Fax

Practice location:
  • Phone: 407-530-5063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA18855
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: