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General NPI Number Information
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NPI Number | 1265153415
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Entity Type | Individual
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Provider Name | ALEXANDER THOMAS KING OTD
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Gender | Male
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Dates
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Enumeration Date | 09/07/2022
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Last Update Date | 09/07/2022
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Provider Practice Location Address
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Address Line | 5855 CHESHIRE PKWY
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City | PLYMOUTH
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State | MN
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Zip | 55446-4005
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Country | US
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Telephone | 763-744-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 2730 AUTUMN DR
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City | ASBURY
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State | IA
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Zip | 52002-2407
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Country | US
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Telephone | 563-845-8467
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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 | 225XG0600X
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Taxonomy Name | Gerontology Occupational Therapist
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License Number | 106937
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License Number State | MN
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