Provider Demographics
NPI:1851772792
Name:O'NEIL, ALEXANDRA F (COTA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:F
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4064 NE 14TH AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-1315
Mailing Address - Country:US
Mailing Address - Phone:614-747-3477
Mailing Address - Fax:
Practice Address - Street 1:4064 NE 14TH AVE
Practice Address - Street 2:UNIT A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-1315
Practice Address - Country:US
Practice Address - Phone:614-747-3477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR315653224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant