Provider Demographics
NPI:1871137802
Name:BREWSTER, ALEXA NOELLE (ATHLETIC TRAINER)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:NOELLE
Last Name:BREWSTER
Suffix:
Gender:F
Credentials:ATHLETIC TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 ANDY DR
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-4910
Mailing Address - Country:US
Mailing Address - Phone:330-564-6939
Mailing Address - Fax:
Practice Address - Street 1:3975 EMBASSY PKWY STE A
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-8319
Practice Address - Country:US
Practice Address - Phone:330-668-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-02
Last Update Date:2019-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0055772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer