Provider Demographics
NPI:1194435891
Name:PERRY, ALEXANDRA CHRISTINE (OTD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:CHRISTINE
Last Name:PERRY
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 N LAKE SHORE DR APT 710
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4917
Mailing Address - Country:US
Mailing Address - Phone:815-222-8293
Mailing Address - Fax:
Practice Address - Street 1:8151 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-3136
Practice Address - Country:US
Practice Address - Phone:708-583-2068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.015239225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist