Healthcare Provider Details

I. General information

NPI: 1396391504
Provider Name (Legal Business Name): ALEXANDRA HULSEY MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 HACIENDA DR
VISTA CA
92081-4542
US

IV. Provider business mailing address

5614 BAJA DR
SAN DIEGO CA
92115-2323
US

V. Phone/Fax

Practice location:
  • Phone: 760-235-4748
  • Fax: 970-385-9546
Mailing address:
  • Phone: 619-980-0621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number29465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: