Provider Demographics
NPI:1558828624
Name:SMITH, ALEXANDRA MARIE (MOTR/L)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 S YALE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-7455
Mailing Address - Country:US
Mailing Address - Phone:918-492-2386
Mailing Address - Fax:
Practice Address - Street 1:5110 S YALE AVE STE 103
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7455
Practice Address - Country:US
Practice Address - Phone:918-492-2386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5320225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist