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General NPI Number Information
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NPI Number | 1619456217
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Entity Type | Individual
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Provider Name | AZALYN HICKMAN OTRL
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Gender | Female
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Dates
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Enumeration Date | 08/14/2018
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Last Update Date | 08/14/2018
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Provider Practice Location Address
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Address Line | 1787 ALLENDALE FAIRFAX HWY
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City | FAIRFAX
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State | SC
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Zip | 29827-9133
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Country | US
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Telephone | 803-632-3311
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Fax |
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Provider Business Mailing Address
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Address Line | 5830 CORAL RIDGE DR STE 300
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City | CORAL SPRINGS
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State | FL
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Zip | 33076-3388
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Country | US
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Telephone | 954-510-4045
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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 | 4741
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5161
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License Number State | SC
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