Provider Demographics
NPI:1164463212
Name:COSTA, ALEXANDER L (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:L
Last Name:COSTA
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 KNOLLCROFT RD
Mailing Address - Street 2:VANJHCS PM&RS (117)
Mailing Address - City:LYONS
Mailing Address - State:NJ
Mailing Address - Zip Code:07939-5001
Mailing Address - Country:US
Mailing Address - Phone:908-647-0180
Mailing Address - Fax:
Practice Address - Street 1:151 KNOLLCROFT RD
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:NJ
Practice Address - Zip Code:07939-5001
Practice Address - Country:US
Practice Address - Phone:908-647-0180
Practice Address - Fax:908-604-5841
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00118200225X00000X
PAOC009227225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist