Provider Demographics
NPI:1619155074
Name:NIEMCZURA, ALEX W (OT)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:W
Last Name:NIEMCZURA
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 E MISSOURI AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2615
Mailing Address - Country:US
Mailing Address - Phone:302-393-0520
Mailing Address - Fax:602-393-0523
Practice Address - Street 1:1020 E MISSOURI AVE STE A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2615
Practice Address - Country:US
Practice Address - Phone:302-393-0520
Practice Address - Fax:602-393-0523
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2905225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist