Provider Demographics
NPI:1487472908
Name:YORK, ALEXIS R (COTA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:R
Last Name:YORK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10527 COYOTE CANYON PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5949
Mailing Address - Country:US
Mailing Address - Phone:505-716-8698
Mailing Address - Fax:
Practice Address - Street 1:4401 SILVER AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2856
Practice Address - Country:US
Practice Address - Phone:505-292-6725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOT-2023-0161224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant