MEDICARE: VICTORIA ELIZABETH VIK OTR/L

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	225X00000X	Occupational Therapist
2	225XH1200X	Hand Occupational Therapist

General Provider Information

NPI Number	:	1740026814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA ELIZABETH VIK OTR/L

Provider Business Mailing Address
First Line	:	1300 OVALTINE CT UNIT 1331
Second Line	:
City	:	VILLA PARK
State	:	IL
Zip	:	60181-2792
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 S ELMHURST RD
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-4240
Country	:	US
Telephone Number	:	224-205-3811
Fax Number	:

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

Provider Enumeration Date	:	07/08/2024
Last Update Date	:	07/08/2024

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