Basic Information
Provider Information
NPI: 1851625776
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ESTES
FirstName: ALEXANDRA
MiddleName: MEGHAN
NamePrefix: MRS.
NameSuffix:  
Credential: OTR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 333 N SUMMIT ST
Address2:  
City: TOLEDO
State: OH
PostalCode: 436041531
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 445 S COUNTY ROAD 525 E
Address2:  
City: AVON
State: IN
PostalCode: 461238361
CountryCode: US
TelephoneNumber: 3177452522
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/24/2009
LastUpdateDate: 09/24/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X31002731AINY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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