Basic Information
| Provider Information | |||||||||
| NPI: | 1689157638 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | CHOJNACKI | ||||||||
| FirstName: | THEA | ||||||||
| MiddleName: | AIDAN | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17700 W CAPITOL DR | ||||||||
| Address2: | |||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530452006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627813083 | ||||||||
| FaxNumber: | 2627813080 | ||||||||
| Practice Location | |||||||||
| Address1: | 2446 N BARTLETT AVE APT B | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532114301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147365992 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2018 | ||||||||
| LastUpdateDate: | 11/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 6323-26 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.