Provider Demographics
NPI:1538835285
Name:D'AMBROSIO, ALEXIS
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:D'AMBROSIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEXI
Other - Middle Name:
Other - Last Name:D'AMBROSIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, ATR-P
Mailing Address - Street 1:3711 LAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415
Mailing Address - Country:US
Mailing Address - Phone:864-707-6332
Mailing Address - Fax:
Practice Address - Street 1:2201 DAYTON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-6415
Practice Address - Country:US
Practice Address - Phone:423-458-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty