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General NPI Number Information
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NPI Number | 1154770865
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Entity Type | Individual
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Provider Name | REBECCA WICKENHEISER
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Gender | Female
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Dates
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Enumeration Date | 06/03/2016
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 5360 N MESA ST STE E5
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City | EL PASO
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State | TX
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Zip | 79912-5820
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Country | US
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Telephone | 915-345-0499
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Fax |
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Provider Business Mailing Address
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Address Line | 5360 N MESA ST STE E5
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City | EL PASO
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State | TX
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Zip | 79912-5820
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Country | US
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Telephone | 915-345-0499
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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 | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number | 36234961
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 134268
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License Number State | TX
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