MEDICARE: ERICA DE ALEJANDRO

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	224Z00000X	Occupational Therapy Assistant	18058	FL

General Provider Information

NPI Number	:	1538821863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA DE ALEJANDRO

Provider Business Mailing Address
First Line	:	2306 EASTMEADOWS CT
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33812-3154
Country	:	US
Telephone Number	:	863-712-2456
Fax Number	:

Provider Business Practice Location Address
First Line	:	6052 PEBBLE BEACH BLVD
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-3601
Country	:	US
Telephone Number	:	863-662-3950
Fax Number	:

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

Provider Enumeration Date	:	10/13/2021
Last Update Date	:	10/13/2021

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Directions to “ ERICA DE ALEJANDRO ” Practice Location

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