Provider Demographics
NPI:1033500418
Name:ALEXANDER, TYNESHIA C (RECREATION THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:TYNESHIA
Middle Name:C
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:RECREATION THERAPIST
Other - Prefix:
Other - First Name:TYNESHIA
Other - Middle Name:C
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10427 19TH AVE SE APT B
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4261
Mailing Address - Country:US
Mailing Address - Phone:425-268-4929
Mailing Address - Fax:
Practice Address - Street 1:10427 19TH AVE SE APT B
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4261
Practice Address - Country:US
Practice Address - Phone:425-268-4929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARE60540316225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist