Provider Demographics
NPI:1750532602
Name:REBNE, ALEXIA ANNE (OTR)
Entity type:Individual
Prefix:MS
First Name:ALEXIA
Middle Name:ANNE
Last Name:REBNE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:ALEXIA
Other - Middle Name:ANNE
Other - Last Name:KARLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:115 E ARNDT ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-2461
Mailing Address - Country:US
Mailing Address - Phone:920-923-7054
Mailing Address - Fax:920-923-7058
Practice Address - Street 1:115 E ARNDT ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-2461
Practice Address - Country:US
Practice Address - Phone:920-923-7054
Practice Address - Fax:920-923-7058
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4635-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4635-026OtherOCCUPATIONAL THERAPIST