Healthcare Provider Details

I. General information

NPI: 1346022894
Provider Name (Legal Business Name): ALEXANDER JOHN USSELMAN OTD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALEX JOHN USSELMAN OTD

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 EAST BLVD
CLEVELAND OH
44106-1702
US

IV. Provider business mailing address

16513 CLIFTON BLVD
LAKEWOOD OH
44107-2340
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-3800
  • Fax:
Mailing address:
  • Phone: 419-602-9335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT012585
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: