Provider Demographics
NPI:1881198471
Name:VONBEHREN, ALEXANDRA N (MOT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:N
Last Name:VONBEHREN
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W CLARENDON AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3420
Mailing Address - Country:US
Mailing Address - Phone:602-279-6905
Mailing Address - Fax:602-279-6934
Practice Address - Street 1:790 N ESTRELLA PKWY STE C
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9290
Practice Address - Country:US
Practice Address - Phone:602-765-4348
Practice Address - Fax:623-233-6567
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010152225XH1200X
AZ008267225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand