Provider Demographics
NPI:1861961971
Name:ALEXANDER, JILLIAN PAIGE-SUE (OTRL)
Entity type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:PAIGE-SUE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MISS
Other - First Name:JILLIAN
Other - Middle Name:PAIGE-SUE
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:1117 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3731
Mailing Address - Country:US
Mailing Address - Phone:810-955-6484
Mailing Address - Fax:
Practice Address - Street 1:ROYAL OAK BEAUMONT- REHAB SERVICES
Practice Address - Street 2:3601 W 13 MILE
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073
Practice Address - Country:US
Practice Address - Phone:248-898-2824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009235225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist