Provider Demographics
NPI:1821073925
Name:MACKENZIE, ALEXANDRA M (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:M
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 NW FLANDERS ST
Mailing Address - Street 2:STE G-1
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3442
Mailing Address - Country:US
Mailing Address - Phone:503-224-9270
Mailing Address - Fax:503-224-9271
Practice Address - Street 1:2330 NW FLANDERS ST
Practice Address - Street 2:STE G-1
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3442
Practice Address - Country:US
Practice Address - Phone:503-224-9270
Practice Address - Fax:503-224-9271
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003472225XH1200X
OR1003686225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR098565021OtherBCBS OF OR
WA173552OtherWA L&I
OR227463Medicaid
WA8419962Medicaid
WA8419962Medicaid