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General NPI Number Information
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NPI Number | 1790144871
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Entity Type | Individual
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Provider Name | MICHELLE L VICKMAN OT
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Gender | Female
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 2 KEEWAYDIN DR
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City | SALEM
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State | NH
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Zip | 03079-2839
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Country | US
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Telephone | 800-995-2673
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Fax | 888-979-6551
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Provider Business Mailing Address
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Address Line | 9718 W TOWER AVE
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City | MILWAUKEE
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State | WI
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Zip | 53224-2997
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Country | US
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Telephone | 262-483-5072
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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 | 075812
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License Number State | IA
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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 | 056011092
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 116567
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5535-26
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License Number State | WI
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