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NPI Code Detail

MEDICARE: ANDREA WILK OT

MEDICARE:   ANDREA  WILK  OT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistOC013334PA
2225X00000XOccupational Therapist

General Provider Information

NPI Number : 1053952911
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA WILK OT
Provider Business Mailing Address
First Line : 1200 CORPORATE DR STE 400
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35242-5424
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3120 PLEASANT VALLEY BLVD
Second Line :
City : ALTOONA
State : PA
Zip : 16602-4309
Country : US
Telephone Number : 814-949-9500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2019
Last Update Date : 09/21/2021

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