Provider Demographics
NPI:1891666848
Name:MAYER, ALEXANDER JORDAN (COTA)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:JORDAN
Last Name:MAYER
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 TARRO WAY
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-3751
Mailing Address - Country:US
Mailing Address - Phone:916-812-4203
Mailing Address - Fax:
Practice Address - Street 1:3600 TARRO WAY
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-3751
Practice Address - Country:US
Practice Address - Phone:916-812-4203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4569224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant