Provider Demographics
NPI:1215633276
Name:NAMYAK, ALEXIS M (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:M
Last Name:NAMYAK
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7510 LANTERN PARK AVE
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-1596
Mailing Address - Country:US
Mailing Address - Phone:607-372-4081
Mailing Address - Fax:
Practice Address - Street 1:7510 LANTERN PARK AVE
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-1596
Practice Address - Country:US
Practice Address - Phone:607-372-4081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
FL24044225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist