Provider Demographics
NPI:1770275455
Name:NOLD, ALEXANDER (OTR)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:NOLD
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9666 GRUWELL WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2448
Mailing Address - Country:US
Mailing Address - Phone:562-299-3219
Mailing Address - Fax:
Practice Address - Street 1:1610 ARDEN WAY STE 195
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4035
Practice Address - Country:US
Practice Address - Phone:916-649-1379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation