1861961971 NPI number — MRS. JILLIAN PAIGE-SUE ALEXANDER OTRL

Table of content: MRS. JILLIAN PAIGE-SUE ALEXANDER OTRL (NPI 1861961971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861961971 NPI number — MRS. JILLIAN PAIGE-SUE ALEXANDER OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALEXANDER
Provider First Name:
JILLIAN
Provider Middle Name:
PAIGE-SUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTRL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLARKE
Provider Other First Name:
JILLIAN
Provider Other Middle Name:
PAIGE-SUE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTRL
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861961971
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1117 W MAPLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48507-3731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-955-6484
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ROYAL OAK BEAUMONT- REHAB SERVICES
Provider Second Line Business Practice Location Address:
3601 W 13 MILE
Provider Business Practice Location Address City Name:
ROYAL OAK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-898-2824
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  5201009235 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)