Provider Demographics
NPI:1689157638
Name:CHOJNACKI, THEA AIDAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:THEA
Middle Name:AIDAN
Last Name:CHOJNACKI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17700 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-2006
Mailing Address - Country:US
Mailing Address - Phone:262-781-3083
Mailing Address - Fax:262-781-3080
Practice Address - Street 1:2446 N BARTLETT AVE APT B
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4301
Practice Address - Country:US
Practice Address - Phone:414-736-5992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6323-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist