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General NPI Number Information
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NPI Number | 1124802962
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Entity Type | Individual
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Provider Name | ALEXANDRIA NIKOLE BASTIN OTD, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/22/2023
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 200 TIMBERLINE DR
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City | MARIETTA
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State | OH
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Zip | 45750-9238
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Country | US
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Telephone | 740-376-0535
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Fax |
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Provider Business Mailing Address
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Address Line | 45160 SWAZEY RD
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City | LEWISVILLE
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State | OH
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Zip | 43754-9412
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Country | US
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Telephone | 919-320-4598
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT011228
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License Number State | OH
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