Provider Demographics
NPI:1417314709
Name:NOVAK, ALESSANDRA F (MS, ATC)
Entity Type:Individual
Prefix:MRS
First Name:ALESSANDRA
Middle Name:F
Last Name:NOVAK
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:MS
Other - First Name:ALESSANDRA
Other - Middle Name:F
Other - Last Name:NACHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:4833 NE 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6334
Mailing Address - Country:US
Mailing Address - Phone:510-220-5637
Mailing Address - Fax:
Practice Address - Street 1:4833 NE 28TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-6334
Practice Address - Country:US
Practice Address - Phone:510-220-5637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-101294252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer