MEDICARE: ALEXIS D'AMBROSIO

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	221700000X	Art Therapist

General Provider Information

NPI Number	:	1538835285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS D'AMBROSIO

Provider Business Mailing Address
First Line	:	3711 LAMAR AVE
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37415
Country	:	US
Telephone Number	:	864-707-6332
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 DAYTON BLVD STE 200
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37415-6415
Country	:	US
Telephone Number	:	423-458-2626
Fax Number	:

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

Provider Enumeration Date	:	08/20/2021
Last Update Date	:	08/20/2021

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Directions to “ ALEXIS D'AMBROSIO ” Practice Location

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