=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174941975
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXANDRA MARIE HOLMES MS, OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2014
-----------------------------------------------------
Last Update Date | 05/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 139 FAIRBANKS RD
-----------------------------------------------------
City | CHURCHVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14428-9782
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-293-1800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 139 FAIRBANKS RD
-----------------------------------------------------
City | CHURCHVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14428-9782
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-293-1800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | OT 17147
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 0187341
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------