Healthcare Provider Details

I. General information

NPI: 1528291739
Provider Name (Legal Business Name): ALEXANDRA ROARK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOSPITAL DR
COLUMBIA MO
65201-5275
US

IV. Provider business mailing address

8830 S SEPULVEDA BLVD
LOS ANGELES CA
90045-4833
US

V. Phone/Fax

Practice location:
  • Phone: 573-814-6000
  • Fax:
Mailing address:
  • Phone: 424-225-1845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number14946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: