MEDICARE: EMMA WILKING M.S. OTR/L

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
1	225XP0200X	Pediatric Occupational Therapist	116092	TX

General Provider Information

NPI Number	:	1588083901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA WILKING M.S. OTR/L

Provider Business Mailing Address
First Line	:	1624 NORFOLK ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-5229
Country	:	US
Telephone Number	:	713-515-2128
Fax Number	:

Provider Business Practice Location Address
First Line	:	1606 W ALABAMA ST
Second Line	:	UNIT A
City	:	HOUSTON
State	:	TX
Zip	:	77006-4102
Country	:	US
Telephone Number	:	713-515-2128
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2014
Last Update Date	:	04/14/2014

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