Provider Demographics
NPI:1861725947
Name:ALEXANDER, PAULA ELAINE (WCMT)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:ELAINE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:WCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W5622 BARKER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WINTER
Mailing Address - State:WI
Mailing Address - Zip Code:54896-7701
Mailing Address - Country:US
Mailing Address - Phone:715-266-6041
Mailing Address - Fax:
Practice Address - Street 1:5168N MAIN STREET
Practice Address - Street 2:
Practice Address - City:WINTER
Practice Address - State:WI
Practice Address - Zip Code:54896
Practice Address - Country:US
Practice Address - Phone:715-266-2627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4002-046225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist