Provider Demographics
NPI:1225307846
Name:ALEXANDER, JORDAN PAUL (COTA)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:PAUL
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 YORKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-8714
Mailing Address - Country:US
Mailing Address - Phone:740-680-7416
Mailing Address - Fax:
Practice Address - Street 1:723 SUMMERS ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-6022
Practice Address - Country:US
Practice Address - Phone:304-428-5573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC1824224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant