Basic Information
| Provider Information | |||||||||
| NPI: | 1669194718 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCOLLUM | ||||||||
| FirstName: | ALEXIS | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | BSHS, MSOT, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 STRATHMORE DR | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080031721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566859562 | ||||||||
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| Practice Location | |||||||||
| Address1: | 243 HURFFVILLE CROSSKEYS RD | ||||||||
| Address2: | |||||||||
| City: | SEWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080804011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003219999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2022 | ||||||||
| LastUpdateDate: | 09/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 46TR01083600 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.