Provider Demographics
NPI:1588692016
Name:ALEXANDER, TARA C (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:C
Last Name:ALEXANDER
Suffix:
Gender:F
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 1:505 BENTON DR
Mailing Address - Street 2:APT 6206
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6325
Mailing Address - Country:US
Mailing Address - Phone:240-355-2899
Mailing Address - Fax:
Practice Address - Street 1:4500 SOUTH LANCASTER ROAD
Practice Address - Street 2:VA MEDICAL CENTER (PM& R 117)
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216
Practice Address - Country:US
Practice Address - Phone:240-355-2899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109855225X00000X, 225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health