Provider Demographics
NPI:1033315445
Name:SAUNDERS, ALEX ALDEN (COTAL)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:ALDEN
Last Name:SAUNDERS
Suffix:
Gender:M
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-9418
Mailing Address - Country:US
Mailing Address - Phone:740-441-9550
Mailing Address - Fax:
Practice Address - Street 1:36759 ROCKSPRINGS RD
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:OH
Practice Address - Zip Code:45769-9730
Practice Address - Country:US
Practice Address - Phone:740-992-6606
Practice Address - Fax:740-992-2678
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03452224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0410817Medicaid