Provider Demographics
NPI:1720524127
Name:NELSON, ALEXANDRA (COTA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:NELSON
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 1:22504 E INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-2173
Mailing Address - Country:US
Mailing Address - Phone:480-388-7785
Mailing Address - Fax:
Practice Address - Street 1:14825 N 54TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2369
Practice Address - Country:US
Practice Address - Phone:480-242-5903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD07431809171W00000X
224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No171W00000XOther Service ProvidersContractor