Healthcare Provider Details

I. General information

NPI: 1760961866
Provider Name (Legal Business Name): ALEXANDRA GELLMAN MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 GREEN ST APT 3F2003
PHILADELPHIA PA
19130-3260
US

IV. Provider business mailing address

2003 GREEN ST APT 3F2003
PHILADELPHIA PA
19130-3260
US

V. Phone/Fax

Practice location:
  • Phone: 973-270-3974
  • Fax:
Mailing address:
  • Phone: 973-270-3974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC018330
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: