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General NPI Number Information
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NPI Number | 1003083858
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Entity Type | Individual
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Provider Name | JILL VICTORIA FYKSEN OTD OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 06/17/2015
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Provider Practice Location Address
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Address Line | 2378 11TH AVE
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City | ADAMS
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State | WI
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Zip | 53910-9722
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Country | US
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Telephone | 608-547-9881
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Fax |
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Provider Business Mailing Address
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Address Line | 2378 11TH AVE
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City | ADAMS
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State | WI
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Zip | 53910-9722
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Country | US
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Telephone | 608-547-9881
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 3856-026
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License Number State | WI
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