Provider Demographics
NPI:1174928535
Name:DEGANN, ALEXANDER (MSOT, OTR/L)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:DEGANN
Suffix:
Gender:M
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 BOULDERS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-327-9242
Mailing Address - Fax:
Practice Address - Street 1:1760 OLD MEADOW RD STE 205
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4330
Practice Address - Country:US
Practice Address - Phone:703-810-5214
Practice Address - Fax:703-810-5475
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4321225X00000X
MA13746225X00000X
VA0119009259225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA13746Medicaid