Healthcare Provider Details

I. General information

NPI: 1841753548
Provider Name (Legal Business Name): ALEXIS MADRID MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date: 09/25/2025
Reactivation Date: 10/16/2025

III. Provider practice location address

2101 NAGLE RD
ERIE PA
16510-2189
US

IV. Provider business mailing address

334 E 36TH ST
ERIE PA
16504-1612
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-7078
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC021082
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: