Provider Demographics
NPI:1144614728
Name:CSAJKO, ALEXANDER (OT)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:CSAJKO
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2045
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:541-266-4526
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2045
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:541-266-4526
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR336600225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP01814024OtherRAILROAD MEDICARE
OR500685167Medicaid
OR1407812365OtherNORTH BEND MEDICAL CENTER GROUP NPI
ORR0000WFBTVOtherNORTH BEND MEDICAL CENTER GROUP MEDICARE
OR161133OtherNORTH BEND MEDICAL CENTER GROUP MEDICAID
OR500685167Medicaid