MEDICARE: THEA AIDAN CHOJNACKI OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	6323-26	WI

General Provider Information

NPI Number	:	1689157638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEA AIDAN CHOJNACKI OTR/L

Provider Business Mailing Address
First Line	:	17700 W CAPITOL DR
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-2006
Country	:	US
Telephone Number	:	262-781-3083
Fax Number	:	262-781-3080

Provider Business Practice Location Address
First Line	:	2446 N BARTLETT AVE APT B
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-4301
Country	:	US
Telephone Number	:	414-736-5992
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2018
Last Update Date	:	11/25/2019

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