Provider Demographics
NPI:1790413979
Name:WALENZ, ALEXANDRIA RAE (COTA)
Entity Type:Individual
Prefix:MISS
First Name:ALEXANDRIA
Middle Name:RAE
Last Name:WALENZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1624 JERRY DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-5021
Mailing Address - Country:US
Mailing Address - Phone:402-707-0399
Mailing Address - Fax:
Practice Address - Street 1:620 N DIERS AVE STE 300
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4985
Practice Address - Country:US
Practice Address - Phone:308-382-0344
Practice Address - Fax:308-382-3241
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant