Active NPI
Alexander Pak, COTA
- Occupational Therapy Assistant
- Milwaukie, OR
National Provider Identifier
1689322315
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 5933
- Practice address
- 4560 SE International Way Ste 100
Milwaukie, OR 97222-4628 - Phone
- (971) 206-5202
- NPI assigned
- Mar 11, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 5933 | CA | Primary |
Addresses
Primary practice location
4560 SE International Way Ste 100
Milwaukie, OR 97222-4628
Mailing address
19712 Corby Ave
Cerritos, CA 90703-7409
Phone (562) 472-9274
Other practice location 1
1045 West Redondo Blvd
Gardena, CA 90247
Phone (310) 553-2695
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5933 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743033600000",
"number": "1689322315",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19712 CORBY AVE",
"city": "CERRITOS",
"state": "CA",
"postal_code": "907037409",
"telephone_number": "562-472-9274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4560 SE INTERNATIONAL WAY STE 100",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "972224628",
"telephone_number": "971-206-5202"
}
],
"practiceLocations": [
{
"address_1": "1045 West Redondo Blvd",
"address_purpose": "LOCATION",
"city": "Gardena",
"state": "CA",
"postal_code": "90247",
"country_code": "US",
"telephone_number": "310-553-2695",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PAK",
"first_name": "ALEXANDER",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-03-11",
"last_updated": "2025-03-27",
"certification_date": "2025-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "CA",
"license": "5933",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukie, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.