Individual
ALEXIS NICCUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
180 W 80TH ST, NEW YORK, NY 10024-6378
(212) 579-2858
(212) 579-2853
Mailing address
6225 RED FOX RD, PENDLETON, IN 46064-9058
(765) 639-8867
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
027668
NY
Other
Enumeration date
05/04/2023
Last updated
05/05/2023
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