Provider Demographics
NPI:1174957260
Name:IWANIUK, ALEXA (COTA/L)
Entity type:Individual
Prefix:MS
First Name:ALEXA
Middle Name:
Last Name:IWANIUK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3357 N COUNTRY CLUB RD APT 9
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1357
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3357 N COUNTRY CLUB RD
Practice Address - Street 2:APT 9
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1367
Practice Address - Country:US
Practice Address - Phone:520-313-8289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist