MEDICARE: WILKER DERONVIL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Z00000X	Orthotist

General Provider Information

NPI Number	:	1528942984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILKER DERONVIL

Provider Business Mailing Address
First Line	:	3767 LAKE WORTH RD STE 114
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-4048
Country	:	US
Telephone Number	:	561-486-9352
Fax Number	:	561-408-1866

Provider Business Practice Location Address
First Line	:	3767 LAKE WORTH RD STE 114
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-4048
Country	:	US
Telephone Number	:	561-486-9352
Fax Number	:	561-408-1866

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2025
Last Update Date	:	07/31/2025

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Directions to “ WILKER DERONVIL ” Practice Location

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