Provider Demographics
NPI:1346086345
Name:STEMM, ALEXANDRA IRENE (ATC, LAT)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:IRENE
Last Name:STEMM
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 SW PICKFORD ST UNIT 103
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-1664
Mailing Address - Country:US
Mailing Address - Phone:909-276-9225
Mailing Address - Fax:
Practice Address - Street 1:801 FERRY ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OR
Practice Address - Zip Code:97114-9709
Practice Address - Country:US
Practice Address - Phone:503-864-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-102453842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer