Provider Demographics
NPI:1053783142
Name:PORTER, ALEXANDER JAMES (OTR/L)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:JAMES
Last Name:PORTER
Suffix:
Gender:M
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 1:66 MILLER DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-5143
Mailing Address - Country:US
Mailing Address - Phone:630-907-9165
Mailing Address - Fax:630-907-9195
Practice Address - Street 1:66 MILLER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-5143
Practice Address - Country:US
Practice Address - Phone:630-907-9165
Practice Address - Fax:630-907-9195
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.011260225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics