Provider Demographics
NPI:1750946802
Name:WYMAN, ALEXANDRA (MS, OTR)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:WYMAN
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9389 W UTE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-6988
Mailing Address - Country:US
Mailing Address - Phone:720-985-5165
Mailing Address - Fax:
Practice Address - Street 1:9389 W UTE DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-6988
Practice Address - Country:US
Practice Address - Phone:720-985-5165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004464225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist