Healthcare Provider Details

I. General information

NPI: 1760627806
Provider Name (Legal Business Name): ALEXANDRA SPIGELMYER ELLIOTT OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 06/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 CHURCH ST.
COLDSPRING TX
77331
US

IV. Provider business mailing address

1575 ROSE HILL RD
COLDSPRING TX
77331-7413
US

V. Phone/Fax

Practice location:
  • Phone: 936-520-6604
  • Fax:
Mailing address:
  • Phone: 936-520-6604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number112401
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: