Provider Demographics
NPI:1679039655
Name:ORR, ALEXANDRA CHARLENE (ATC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:CHARLENE
Last Name:ORR
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 W UNIVERSITY ST # 407
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7824
Mailing Address - Country:US
Mailing Address - Phone:309-846-1902
Mailing Address - Fax:
Practice Address - Street 1:1111 N GLENSTONE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-2125
Practice Address - Country:US
Practice Address - Phone:309-846-1902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180276592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer