Provider Demographics
NPI:1285059600
Name:DEVRIES, ALEXANDRA KAY (OT)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:KAY
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:KAY
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 W SCHAUMBURG RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3502
Mailing Address - Country:US
Mailing Address - Phone:847-490-7100
Mailing Address - Fax:
Practice Address - Street 1:1051 W US ROUTE 6
Practice Address - Street 2:STE 400
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-4200
Practice Address - Country:US
Practice Address - Phone:815-942-8301
Practice Address - Fax:815-942-8449
Is Sole Proprietor?:No
Enumeration Date:2014-02-21
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-010428225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400143095Medicare PIN