Provider Demographics
NPI:1679137889
Name:ALEXANDER, AUBREY (MOTR/L)
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:AUBREY
Other - Middle Name:
Other - Last Name:PETZOLDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:8224 DELLWOOD RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-2416
Mailing Address - Country:US
Mailing Address - Phone:505-550-1192
Mailing Address - Fax:
Practice Address - Street 1:8224 DELLWOOD RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2416
Practice Address - Country:US
Practice Address - Phone:505-550-1192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOT3898225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty