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NPI Code Detail

MEDICARE: MRS. JULIE ANN WICKER OT

MEDICARE: MRS. JULIE ANN WICKER 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
1225X00000XOccupational Therapist104866TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28T2729OTHERTXBCBS PROVIDER #

General Provider Information

NPI Number : 1184608796
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JULIE ANN WICKER OT
Provider Business Mailing Address
First Line : PO BOX 8266
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76307-8266
Country : US
Telephone Number : 940-500-8859
Fax Number : 940-696-6210
Provider Business Practice Location Address
First Line : 1709 10TH ST
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76301-5010
Country : US
Telephone Number : 940-500-8859
Fax Number : 940-696-6210
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2005
Last Update Date : 03/08/2017

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Directions to “ MRS. JULIE ANN WICKER OT” Practice Location

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