Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT.5729 | SC |
NPI | 1033754056 |
---|---|
Provider Name | Alexa Melaine Royer |
First Address | Brunswick, GA 31523-3504 |
Second Address | Bluffton, SC 29910-8967 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2019 |
Last Update Date | 13/11/2019 |