Provider Demographics
NPI:1265153415
Name:KING, ALEXANDER THOMAS (OTD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:THOMAS
Last Name:KING
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 AUTUMN DR
Mailing Address - Street 2:
Mailing Address - City:ASBURY
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2407
Mailing Address - Country:US
Mailing Address - Phone:563-845-8467
Mailing Address - Fax:
Practice Address - Street 1:5855 CHESHIRE PKWY
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-4005
Practice Address - Country:US
Practice Address - Phone:763-744-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106937225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology