Healthcare Provider Details

I. General information

NPI: 1629138375
Provider Name (Legal Business Name): ELIZABETH J ALEXANDER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH J WILSON OTR

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 VETERANS MEMORIAL PKWY
RIVERSIDE RI
02915-5061
US

IV. Provider business mailing address

1011 VETERANS MEMORIAL PARKWAY
EAST PROVIDENCE RI
02915
US

V. Phone/Fax

Practice location:
  • Phone: 401-432-1000
  • Fax: 401-432-1500
Mailing address:
  • Phone: 401-432-1000
  • Fax: 401-432-1500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT00840
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: