Healthcare Provider Details

I. General information

NPI: 1427622950
Provider Name (Legal Business Name): BROOKLYN WIKSTROM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 1ST AVE
MIDDLETOWN OH
45044-4124
US

IV. Provider business mailing address

400 N ERIE HWY STE A
HAMILTON OH
45011-4264
US

V. Phone/Fax

Practice location:
  • Phone: 513-422-0713
  • Fax:
Mailing address:
  • Phone: 513-887-3710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA008452
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: