Provider Demographics
NPI:1700554953
Name:COUGHLIN, ALEXANDRA
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17725 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-8173
Mailing Address - Country:US
Mailing Address - Phone:405-919-5546
Mailing Address - Fax:
Practice Address - Street 1:OKLAHOMA PEDIATRIC THERAPY CENTER
Practice Address - Street 2:1824 COMMONS CIRCLE
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-7309
Practice Address - Country:US
Practice Address - Phone:405-467-6782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty