Provider Demographics
NPI:1144993494
Name:ENRIQUEZ, ALEXANDRIA LOUISE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRIA
Middle Name:LOUISE
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:ALEXANDRIA
Other - Middle Name:LOUISE
Other - Last Name:CROWE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:606 N 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-5330
Mailing Address - Country:US
Mailing Address - Phone:253-344-8865
Mailing Address - Fax:
Practice Address - Street 1:2121 NE 139TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2301
Practice Address - Country:US
Practice Address - Phone:360-487-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61121668225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist