MEDICARE: ALEXANDRA ROSE MARTIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	056077624	IL

General Provider Information

NPI Number	:	1245717834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA ROSE MARTIN

Provider Business Mailing Address
First Line	:	2336 TARA DR
Second Line	:
City	:	ELGIN
State	:	IL
Zip	:	60123-4936
Country	:	US
Telephone Number	:	847-287-9302
Fax Number	:

Provider Business Practice Location Address
First Line	:	4710 W 95TH ST
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2453
Country	:	US
Telephone Number	:	708-422-2960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2018
Last Update Date	:	10/01/2024

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