Provider Demographics
NPI:1124768031
Name:MALMIS, ALEXANDRA (OTR/L)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:MALMIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17154 NW 87TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2727 NW 167TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-4406
Practice Address - Country:US
Practice Address - Phone:305-622-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2023-01-24
Deactivation Date:2022-04-06
Deactivation Code:
Reactivation Date:2022-05-02
Provider Licenses
StateLicense IDTaxonomies
FLOT22886225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics