Provider Demographics
NPI:1679365936
Name:JUDYCKI, ALEXANDRA STANDISH (COTA/L)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:STANDISH
Last Name:JUDYCKI
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:RED RIVER
Mailing Address - State:NM
Mailing Address - Zip Code:87558-0393
Mailing Address - Country:US
Mailing Address - Phone:575-779-5159
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 393
Practice Address - Street 2:
Practice Address - City:RED RIVER
Practice Address - State:NM
Practice Address - Zip Code:87558-0393
Practice Address - Country:US
Practice Address - Phone:575-779-5159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOTA3945224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant