Healthcare Provider Details

I. General information

NPI: 1427757624
Provider Name (Legal Business Name): NICHOLAS ALEXANDER OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MONARCH PT
GREENEVILLE TN
37745-4637
US

IV. Provider business mailing address

180 HANKINS SPRING LN
GREENEVILLE TN
37745-1830
US

V. Phone/Fax

Practice location:
  • Phone: 423-609-7997
  • Fax: 423-609-7033
Mailing address:
  • Phone: 423-588-6068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7576
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: