Provider Demographics
NPI:1326438144
Name:ALEXANDER, DYAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:DYAN
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
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 1:11 PANORAMA TRL
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-5603
Mailing Address - Country:US
Mailing Address - Phone:817-271-9881
Mailing Address - Fax:
Practice Address - Street 1:1919 BRINKER RD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208
Practice Address - Country:US
Practice Address - Phone:940-503-1178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-01
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000004460225X00000X
TX110334225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNOT0000004460OtherOY LICENSE