Provider Demographics
NPI:1225582034
Name:MACGREGOR, ALEXANDER BRUCE I (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:BRUCE
Last Name:MACGREGOR
Suffix:I
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 1:11053 SAN JUAN ST APT B
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2778
Mailing Address - Country:US
Mailing Address - Phone:818-933-1318
Mailing Address - Fax:
Practice Address - Street 1:11053 SAN JUAN ST APT B
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2778
Practice Address - Country:US
Practice Address - Phone:818-933-1318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT16540225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation