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NPI Code Detail

MEDICARE: ALEXA MANGINI MSOT OTR/L

MEDICARE: ALEXA MANGINI MSOT OTR/L
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
1225X00000XOccupational Therapist020043NY

General Provider Information

NPI Number : 1568829547
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXA MANGINI MSOT OTR/L
Provider Business Mailing Address
First Line : 3767 HYLAN BLVD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10308-3505
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3767 HYLAN BLVD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10308-3505
Country : US
Telephone Number : 718-605-4301
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2016
Last Update Date : 01/21/2016

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