Provider Demographics
NPI:1255619102
Name:ALEXANDER, PRISCILLA RUTH (COTA/L CLT)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:RUTH
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:COTA/L CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17305 WOOLWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-1131
Mailing Address - Country:US
Mailing Address - Phone:402-980-6049
Mailing Address - Fax:
Practice Address - Street 1:17305 WOOLWORTH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-1131
Practice Address - Country:US
Practice Address - Phone:402-980-6049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE739224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant