Provider Demographics
NPI:1083612113
Name:ALEXANDER, PATRICIA READICK (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:READICK
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:READICK
Other - Last Name:DOUTHITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:6050 CONEJO RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-1829
Mailing Address - Country:US
Mailing Address - Phone:805-462-3430
Mailing Address - Fax:
Practice Address - Street 1:1414 PARK ST
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-2160
Practice Address - Country:US
Practice Address - Phone:805-237-0272
Practice Address - Fax:805-237-2416
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT51902083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWN467662AMedicare ID - Type Unspecified