Healthcare Provider Details

I. General information

NPI: 1861082273
Provider Name (Legal Business Name): ALEXANDRA PAIGE NICHOLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MOE RD
CLIFTON PARK NY
12065-3821
US

IV. Provider business mailing address

2240 ROSENDALE RD
NISKAYUNA NY
12309-2702
US

V. Phone/Fax

Practice location:
  • Phone: 518-280-4294
  • Fax:
Mailing address:
  • Phone: 518-925-0869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number025217
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: