Provider Demographics
NPI:1093310575
Name:GATES, ALEXANDRA M (CPO)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:M
Last Name:GATES
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8880 SW NIMBUS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7111
Mailing Address - Country:US
Mailing Address - Phone:503-765-5081
Mailing Address - Fax:
Practice Address - Street 1:1424 N MCDONALD RD STE 201
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-6017
Practice Address - Country:US
Practice Address - Phone:509-926-1403
Practice Address - Fax:509-926-1404
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOI60220931222Z00000X
WAPS60220933224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist