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General NPI Number Information
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NPI Number | 1932716941
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Entity Type | Individual
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Provider Name | ALEXANDRA ANITA DE LA RUA OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/24/2020
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Last Update Date | 10/14/2020
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Provider Practice Location Address
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Address Line | 675 THIRD AVENUE 5TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10017
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Country | US
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Telephone | 212-922-1001
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Fax | 212-922-0033
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Provider Business Mailing Address
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Address Line | 1901 DORSET DRIVE
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City | TARRYTOWN
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State | NY
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Zip | 10591
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Country | US
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Telephone | 845-689-4183
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 024747
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 024747
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License Number State | NY
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