Provider Demographics
NPI:1548653306
Name:LOFDAHL, ALEXANDRA I
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:LOFDAHL
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17714 80TH STREET KP N
Mailing Address - Street 2:
Mailing Address - City:VAUGHN
Mailing Address - State:WA
Mailing Address - Zip Code:98394-9005
Mailing Address - Country:US
Mailing Address - Phone:253-318-2872
Mailing Address - Fax:
Practice Address - Street 1:17714 80TH STREET KP N
Practice Address - Street 2:
Practice Address - City:VAUGHN
Practice Address - State:WA
Practice Address - Zip Code:98394-9005
Practice Address - Country:US
Practice Address - Phone:253-318-2872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC 60530918224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant