Provider Demographics
NPI:1649479734
Name:PHOENIX, ALEXANDRA G (OTR/L)
Entity type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:G
Last Name:PHOENIX
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8116 GOLDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4407
Mailing Address - Country:US
Mailing Address - Phone:763-512-1822
Mailing Address - Fax:
Practice Address - Street 1:715 FLORIDA AVE S
Practice Address - Street 2:SUITE 206
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55426-1719
Practice Address - Country:US
Practice Address - Phone:763-541-1671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101676225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist