Provider Demographics
NPI:1366016636
Name:WOJTALEWICZ, ALYSSA MARIE
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARIE
Last Name:WOJTALEWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1189 JANSEN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:NE
Mailing Address - Zip Code:68873-6843
Mailing Address - Country:US
Mailing Address - Phone:402-990-5322
Mailing Address - Fax:
Practice Address - Street 1:1405 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:NE
Practice Address - Zip Code:68873-3618
Practice Address - Country:US
Practice Address - Phone:308-754-5486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-09-17
Deactivation Date:2021-06-14
Deactivation Code:
Reactivation Date:2021-07-22
Provider Licenses
StateLicense IDTaxonomies
NE1127224Z00000X
224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty