Provider Demographics
NPI:1225512965
Name:GROSSMAN, ALEXANDRIA E (OTR)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:E
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13642 N HIGHWAY 183 STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-2210
Mailing Address - Country:US
Mailing Address - Phone:512-331-4115
Mailing Address - Fax:512-331-8176
Practice Address - Street 1:13642 N HIGHWAY 183 STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2210
Practice Address - Country:US
Practice Address - Phone:512-331-4115
Practice Address - Fax:512-331-8176
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119271225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics