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General NPI Number Information
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NPI Number | 1083359772
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Entity Type | Individual
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Provider Name | KAYLEE ROSE WICKMAN OTR
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Gender | Female
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Dates
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Enumeration Date | 04/28/2022
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 2995 SUB ZERO PKWY
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City | FITCHBURG
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State | WI
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Zip | 53719-8801
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Country | US
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Telephone | 608-819-6394
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Fax |
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Provider Business Mailing Address
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Address Line | 3836 MAPLE GROVE DR APT 104
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City | MADISON
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State | WI
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Zip | 53719-1896
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Country | US
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Telephone | 608-588-5567
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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 | 7273-26
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License Number State | WI
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