Provider Demographics
NPI:1508511502
Name:MASON, ALEXANDRA DONN (OTA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:DONN
Last Name:MASON
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 NURSERY RD APT 29-204
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-7642
Mailing Address - Country:US
Mailing Address - Phone:412-852-2732
Mailing Address - Fax:
Practice Address - Street 1:3456 21ST AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-3213
Practice Address - Country:US
Practice Address - Phone:727-327-1988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant