Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 001986 | IA |
NPI | 1134707268 |
---|---|
Provider Name | Jackie Wilke |
First Address | Urbandale, IA 50323-2636 |
Second Address | West Des Moines, IA 50266-8592 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2021 |
Last Update Date | 30/03/2021 |