Provider Demographics
NPI:1528692027
Name:ALEXANDER, KATRINA (OTA)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6516 MONTROSE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-2229
Mailing Address - Country:US
Mailing Address - Phone:703-328-5206
Mailing Address - Fax:
Practice Address - Street 1:46531 HARRY BYRD HWY
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-3555
Practice Address - Country:US
Practice Address - Phone:703-834-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002311224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant