Provider Demographics
NPI:1083396436
Name:FRONCKOWIAK, LEANNA MARIE (OTD)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:MARIE
Last Name:FRONCKOWIAK
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10601 S 72ND ST
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3407
Mailing Address - Country:US
Mailing Address - Phone:402-932-2782
Mailing Address - Fax:
Practice Address - Street 1:10601 S 72ND ST
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3407
Practice Address - Country:US
Practice Address - Phone:402-932-2782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2815225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist