Basic Information
| Provider Information | |||||||||
| NPI: | 1295164051 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALEXANDER | ||||||||
| FirstName: | CARISSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8011 108TH ST SE | ||||||||
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| City: | MIDDLEVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493339302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6165402140 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 W MICHIGAN ST | ||||||||
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| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532032903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162613960 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2013 | ||||||||
| LastUpdateDate: | 06/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 5202007123 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.