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General NPI Number Information
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NPI Number | 1366928392
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Entity Type | Individual
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Provider Name | ELIZABETH AMBER WILKE MOT, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 04/29/2023
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Provider Practice Location Address
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Address Line | 1620 BOSTON POST RD STE 200
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City | WESTBROOK
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State | CT
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Zip | 06498-2094
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Country | US
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Telephone | 203-453-7592
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Fax |
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Provider Business Mailing Address
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Address Line | 39 WELLINGTON DR
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City | FARMINGTON
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State | CT
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Zip | 06032-3210
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Country | US
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Telephone |
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 5026
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License Number State | CT
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