Provider Demographics
NPI:1871125310
Name:FELDMAN, ALEXANDRA (LMBT, OTR)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:LMBT, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BERKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-3338
Mailing Address - Country:US
Mailing Address - Phone:803-415-7442
Mailing Address - Fax:
Practice Address - Street 1:1180 HAYWOOD RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-2286
Practice Address - Country:US
Practice Address - Phone:864-740-1145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9289225700000X
NC14849225700000X
NC12831225X00000X
FL20279225X00000X
SC5725225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist