Healthcare Provider Details

I. General information

NPI: 1356593131
Provider Name (Legal Business Name): KEVIN MICHAEL WILCHER D.P.T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 N MACARTHUR BLVD STE H
OKLAHOMA CITY OK
73162-1849
US

IV. Provider business mailing address

440 MERCHANT DR
NORMAN OK
73069-6470
US

V. Phone/Fax

Practice location:
  • Phone: 405-809-8660
  • Fax: 405-603-6676
Mailing address:
  • Phone: 405-809-8713
  • Fax: 405-573-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4159
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: