Provider Demographics
NPI:1104347293
Name:ACEVEDO ALI, ALEJANDRO REY (OTR)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:REY
Last Name:ACEVEDO ALI
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 S 46TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3734
Mailing Address - Country:US
Mailing Address - Phone:717-682-5617
Mailing Address - Fax:
Practice Address - Street 1:1127 S 46TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-3734
Practice Address - Country:US
Practice Address - Phone:717-682-5617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist