Provider Demographics
NPI:1194438556
Name:FRONK, ALEXSANDRA NICOLE (COTA)
Entity type:Individual
Prefix:
First Name:ALEXSANDRA
Middle Name:NICOLE
Last Name:FRONK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:ALEXSANDRA
Other - Middle Name:NICOLE
Other - Last Name:PJEVACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:S31 W24971 SUNSET DRIVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:410 N MAIN ST. THREE PILLARS
Practice Address - Street 2:
Practice Address - City:DOUSMAN
Practice Address - State:WI
Practice Address - Zip Code:53118
Practice Address - Country:US
Practice Address - Phone:800-848-5306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7040-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant