Provider Demographics
NPI:1225775570
Name:ALEXANDER, JESSIE ANGELIKA (OTR/L)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:ANGELIKA
Last Name:ALEXANDER
Suffix:
Gender:
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 1:555 S CATLIN ST APT 218
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-1650
Mailing Address - Country:US
Mailing Address - Phone:406-282-3128
Mailing Address - Fax:406-924-7022
Practice Address - Street 1:555 S CATLIN ST APT 218
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-1650
Practice Address - Country:US
Practice Address - Phone:406-282-3128
Practice Address - Fax:406-924-7022
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0005317225X00000X
174H00000X
MTOTP-OT-LIC-9058225XP0019X, 225XR0403X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174H00000XOther Service ProvidersHealth Educator
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation